The Three Biggest Mistakes Nurses Make with EMRs


Electronic medical records were designed for greater efficiency, but these common errors can compromise the integrity of patient records

By Melissa Wirkus Hagstrom, contributor

Electronic medical records (EMRs), or electronic health records (EHRs), were created to make collecting and documenting critical patient information faster, easier and safer for everyone involved. Now that most facilities have made the switch to EMRs, some issues have come to light that require corrective action, especially in regards to information that is input into the systems.

A key concern with EMRs is in the area of data integrity failures, which ECRI Institute highlights in their Top 10 Patient Safety Concerns for Healthcare Organizations report. Compromised data can include a wide variety of issues, from data entry errors and missing or delayed data to the inappropriate use of default values, copying and pasting older information into a new report, and the use of both paper and electronic systems simultaneously for patient care.

Here, looks at the top three mistakes nurses and other health care clinicians make with EMRs:

1. Omitting information and inputting incorrect data

William Marella, executive director, operations and analytics, ECRI Institute, presented at the HIMSS15 Annual Conference in April 2015 and discussed some of the major challenges and risks that have been identified in the health care setting as a result of the rapid adoption of electronic patient records.

“There are a lot of issues around making sure that the information that gets into the EMR is timely, and relevant and complete; and that it is getting in there without errors creeping into it,” he said. “Sometimes people can put in the wrong information, other times the wrong information can get into the medical record from a medical device that might be incorrectly mapped between the linked systems.”

The integrity of the data in patient records is extremely important, Marella stressed. As physicians and nurses are being pressured to take care of more patients in less time, they are relying on the data in these electronic systems to make important decisions. If the data is compromised, so are the health decisions that clinicians are making.

“The kinds of things we are seeing are information being omitted that should get into the EHR, like a lab result gets reported, but no one records it in the EMR. Or, they record it in the EMR, but they record it incorrectly,” Marella said.

Nurses can avoid leaving information out or inputting it incorrectly by exercising a variety of different tactics, such as leveraging system defaults and using quality control methodologies.

2. Mixing up patient information

Another issue arises with respect to patient identification, Marella explained. “A lot of times you can have multiple patient records open at the same time and people can introduce errors that way when they put something in one patient’s record that they really intended to put in another patient’s record.”

Nurses can be more diligent about double-checking patient IDs when in the system and ensuring they are not copying and pasting information into the incorrect file or forgetting to edit the copied information once it is pasted.

In addition to mixing up patient records, another common problem highlighted in ECRI’s Top 10 list is mixing up pounds and kilograms in respect to patient weight.

“Patients’ medication doses are often calculated based on our understanding of the patient’s weight, and if that understanding isn’t correct, that can cause problems and frequently leads to overdoses or under-doses of some pretty significant medications.”

3. Inadequate training

Although training is typically seen as a management issue, it is essential for nurses of every practice level to speak up if they feel they have had inadequate training; they may even take their training into their own hands in order to ensure they are entirely comfortable and competent with the technology before using it in the patient care setting.

“A lot of it is good training and good documentation practices within the institution,” Marella said. “Particularly when you are dealing with nurses coming in from outside the organization--like temp nurses or even nurses in the float pool if they are working in a department that they don’t normally work in--they need to understand just what the documentation practices are and what the expectations are.”

Being aware of errors and possessing a healthy level of skepticism are two keys to avoiding some of the common mistakes with electronic medical records. “If you see information that is contradicted by other information you know, then you should question it and not assume that it’s correct,” Marella concluded.

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