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Study Finds EHR Errors Related to Default Values Could Affect Patient Safety

September 6, 2013
by Rajiv Leventhal
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Of the more than 300 events related to electronic health record (EHR) software default values analyzed by the Pennsylvania Patient Safety Authority, three percent resulted in unsafe conditions or prolonged hospitalization of patients, according to the Authority’s new report.

The report analyzed 324 EHR default values—which are the preset medication, dose and delivery—that led to events, aiming to give Pennsylvania healthcare facilities information they can use to avoid EHR events such as wrong-time and wrong-dose errors.

Default values for time are often put into medication and lab orders to coordinate staff resources. Automated stop times are used to end drug orders after a certain amount of time unless a doctor or healthcare provider renews the order. However, EHR event reports show that patient harm can sometimes occur if these defaults are not used appropriately.

“Default values are often used to add standardization and efficiency to hospital information systems," Erin Sparnon, patient safety analyst for the Pennsylvania Patient Safety Authority, said in a statement. "For example, a healthy patient using a pain medication after surgery would receive a certain medication, dose and delivery of the medication already preset by the healthcare facility within the EHR system for that type of surgery."

Sparnon said of the 324 verified reports, 314 (97 percent) were reported as "event, no harm" meaning an error did occur, but there was no harm to the patient. Six were reported as "unsafe conditions" that did not result in a harmful event. Two reports involving temporary harm that required treatment or intervention involved accepting a default dose of muscle relaxant which was higher than the intended dose, and giving an extra dose of morphine by accepting a default administration time which was too soon after the patient's last dose.

Two other reports involved temporary harm that required initial or prolonged hospitalization. In the first report, a patient's temperature spiked after a default stop time automatically cancelled an antibiotic. In the second report, a patient's sodium levels kept rising because a default note to administer an ordered antidiuretic "per respiratory therapy" caused nurses not to administer the drug because they thought (incorrectly) respiratory therapy was doing so.

The three most commonly reported error types were wrong-time errors (200), wrong-dose errors (71), and inappropriate use of an automated-stopping function (28).

"Many of these reports also showed a source of erroneous data and the three most commonly reported sources were failure to change a default value, user-entered values being overwritten by the system and failure to completely enter information which caused the system to insert information into blank parameters," Sparnon said. "There were also nine reports that showed a default value needed to be updated to match current clinical practice."

The Authority analysis gives healthcare providers insight into the types and sources of error identified with EHRs and considerations that should be made when using default values.

"The analysis shows that healthcare providers should consider their use of default values in order sets particularly when considering how users see and enter time information, how they address errors related to situations in which default values have not kept up with changes in clinical practice and consider whether EHR software allows users to easily tell the difference between user-entered data and system-entered data," Sparnon added.

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