Electronic medical records are supposed to make it easier for nurses to document patient care so doctors can make informed decisions about effective treatment. That’s not happening according to one doctor who is sounding the alarm about the unexpected distraction that occurs when nurses interface with EMR technology.
In a recent Wall Street Journal blog, cardiologist and flight surgeon John Sotos, MD, says nurses are distracted with their tablets and computers and are missing or failing to record critical details that can result in serious harm to patients. He says before EMR, it took seconds to record a basic detail like a patient’s urination on a clipboard hanging at the foot of the patient’s bed.
With EMR technology, that same task “requires the nurse to walk to the computer, sign on to the EMR (itself a chore), grasp the mouse, select the patient, click a ‘urination’ tab (eventually), move hands to keyboard, type the volume of urine, then click ‘save’.” Any interruption during that process, and key data might not get recorded.
That was the case for a patient Sotos refers to as “Alex.” Alex suffered mild injuries during a hospital stay because the nursing staff failed to accurately keep track of her fluids on three separate occasions. On her first day, they forgot to order IV fluids, the second day they ordered three times too much, and on the third day they failed again to order the fluids . While this oversight was not life-threatening, the patient, who had venous catheters in both legs, was forced to use a bed pan every 20 minutes on the second day because of the excess fluids. All the movement to use the bed pan triggered so much bleeding around the catheters in her legs that she soaked a blanket. Her nurse had to call a doctor at home at 1 a.m. to examine the bleeding and re-bandage her.
“Detecting Alex’s fluid mismanagement required only a glance at her, a glance at the I.V. pole next to her, and a modicum of thought. Obviously, the glances and thought didn’t happen… three times,” Sotos says.
According to Sotos, the current design of EMR technology is largely responsible for errors like the ones that occurred in the case of Alex. EMR interfaces require too much attention from the user and need to be “designed to be undemanding of attention and cognition,” like cockpit controls in an aircraft.
To learn more, read the entire blog.
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