Critical Thinking- Week 10

The registered nurse (RN) in reviewing orders and completing the medication reconciliation (Med Rec) in the electronic Medical Record (EMR). Med Rec is a process for double checking medications, where the RN verifies that the details of the medications written on the provider's orders match those recorded in the medication administration record (MAR) used by the nurse. During the Med Rec process, several alarms/alerts go off.

• Does the use of EMR guarantee error-free patient care? If yes, why? If no, why?
• The use of EMR does not guarantee error-free patient care. The EMR has the potential to contribute to medical errors if policies and procedures, as well as monitoring of compliance, are not carefully developed and implemented. 
• What types of nursing behavior regarding the use of EMR's might contribute to jeopardizing patient safety?
• Copy and Past (Cloning): Copying information from a an earlier instance and pasting it into the record for a current visit could carry forward information that is neither accurate nor appropriate for the encounter. Copy and paste also runs the risk of duplicating an error multiple times.
• Templates: Although templates can enhance documentation, they may result in inaccurate information fi they are not individualized to the patient. For example, a template for a neurological assessment, with a box for "normal value," would indicate that the patient was alert and oriented to time, place, and person even though the patient was an infant.
• Computerized Physician Order Entry (CPOE): Pre-programmed prescription orders for common drugs and dosages make it easy to selecta n unintended drug or dose from drop down menus. In addition, many EMR systems include routine pop-ups for drug dosages, interactions, and allergies, and with the hectic schedule of a nurse, there is a tendency for them to ignore warnings, routinely override, or even turn off such "patient safety" prompts.
• Untimely Record Modification: If modification to records is not transparent, EMR alterations can potentially be subject to allegations of fraud and incomplete records.
• What are the dangers of excessive system alerts in computer charting systems?
• The nurse could be subject to allegations of fraud and incomplete records. The nurse may not remember exactly what was done or administered, and the specific times that these things happened. If she inputs the wrong times, medications give, or implementations performed this could cause other nurses to have dangerous behaviors as well. 
• How can the nurse guard against the potential effect?
• Establish personal and practice policies regarding electronic order entry.
• Use the systems and policies in place for dealing with orders and charring that occur when the workstation or system is temporarily down.
• Bring out progress notes and evaluate them from time to time
• Beware of generic templates.
• Become familiar with the tracking features of the EMR
• Print out a note to be sure your entries are in your own name.
• Understand how the time-stamp feature works, so that you can time your documentation accordingly.
• Ensure that only appropriate staff members have had access to your patients records.