How the electronic medical record can turn on you

[MillCreek]

https://medium.com/backchannel/how-technology-led-a-hospital-to-give-a-patient-38-times-his-dosage-ded7b3688558

Complex systems can produce complex results.

[Firethorn]

Did you read the part about how, despite this, the problem is typically far worse in 'traditional' systems?  It was 1 in 15 adverse drug events back when pen & paper was used, 'many' of them from drug administration errors.

I'm not saying we shouldn't keep improving them, mind you.

[vaskidmark]

he best defense against medication screwups is an informed patient that knows why he is prescribed a particular medication, what if any side effects it may cause, how much how often he is to get it, and then checks the nurse as she lays out that smorgesbrod of pills.

Sadly, this does not work for most folks who are sick enough to be in a hospital in the first place, and definately does not work for the young.  It also does not work for parents who both cannot spend 24/7 at their child's bedside and who are mostly caught up in the doctor-as-godhead syndrome.

What I have had the pleasure of experiencing at the local VA is finding out that my wristband "talks to" both the pharmacy and the meds cart in verifying the order the doctor entered.  Now my main concern is seeing the doc enters the order properly.  (Example: my diuretics are Rx'd tid and can be given up to half-way to the next scheduled dose -- except that no diuretic can be administered between 8 PM and 4 AM or within 4 hours of administering any sedative.  My doc and I work this out every time I am admitted mostly because he hates being called by the head nurse for instructions on how to deal with a patient who is refusing meds.)  (Yes, when I am going to be knocked out or immobilized I get the dreaded Foley catheter.)

Sadly, I would bet that less than 10% of the patients know about this, and that the doctors/nurses do not try to explain it to patients.

stay safe.

[roo_ster]

The hospital where my wife no longer works rates them to a great extent on how many warnings they do/do not generate and if they jump on them before the time out.  Spending time to confirm a hinkey medication dosage may very well generate a warning flag that will then result in a reprimand. 

The IT system and its outputs are the primary source for their annual eval. 

[MikeB]

Shouldn't the nurse have questioned the prescription? Seems like relying on the computer to the point of not paying attention to me.

[MillCreek]

Shouldn't the nurse have questioned the prescription? Seems like relying on the computer to the point of not paying attention to me.

The article is in five parts, and one of the parts discusses this very point at length.  In a nutshell, the nurse thinks she should have, and there are a number of good reasons why she did not.

[MikeB]

The article is in five parts, and one of the parts discusses this very point at length.  In a nutshell, the nurse thinks she should have, and there are a number of good reasons why she did not.

Fair enough. I read the first two parts and thought there should have been an obvious clue to the nurse and/or dispensary that something was wrong. Will need to read the rest.

[Firethorn]

The article is in five parts, and one of the parts discusses this very point at length.  In a nutshell, the nurse thinks she should have, and there are a number of good reasons why she did not.

Yeah, 'just' enough trust in the system to not question it, enough time to be on her own and not want to call for help, not enough time to know better.

[Hawkmoon]

"Welcome to Westworld, where nothing can go wrong ..."