Safety solutions

Informatics

Patient safety and IT trends

By Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, FAAN
s care coordinators, nurses have a primary
responsibility to be aware of the potential risks
that may accompany the increasing use of
technology in the healthcare environment.
Being able to capture and document patient
data at the point of care in an electronic format
brings with it many benefits. But there are also
inherent risks that come
with the use of health
information technology
(IT) that may impact
patient safety and data
integrity.
Consider these examples:
A medication is prescribed to be given as an
I.M. injection. Its actually
intended to be given I.V.;
however, the physician
selects the wrong delivery
route from the drop-down
menu when prescribing
the drug in the electronic
health record (EHR)
system.
A pharmacist processes a
medication prescription for
acetaminophen for the
wrong patient because he
has two patient records
open at the same time and
becomes distracted during
the prescribing process.
There are also many examples of how well-designed
EHRs and strong clinical processes can improve safety
through their ability to provide historical data, offer
clinical decision support, and facilitate communication
among care providers.1 In order to realize these benefits,

24

November 2015 Nursing Management

its important to identify and analyze the factors that

can lead to health IT-related errors.

How do we minimize risks?

The Joint Commission has issued a Sentinel Event
Alert on the safe use of health IT.2 This report analyzes factors contributing to 120 health IT-related
sentinel events. The analysis focused on eight general
categories:
human-computer interface
(33%)ergonomics and
usability issues resulting in
data-related errors
workflow and communication (24%)issues relating
to health IT support of communication and teamwork
clinical content (23%)
design or data issues relating to clinical content or
decision support
internal organizational
policies, procedures, and
culture (6%)
people (6%)training and
failure to follow established
processes
hardware and software (6%)
external factors
(1%)vendor and other
external issues
system measurement and monitoring (1%).
Recommended actions to reduce these risk factors
include creating an organization-wide culture of safety
and implementing effective change management protocols. These actions involve systematically analyzing
each adverse event to determine if health IT played a
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role and what can be done to prevent a similar event from happening in the future.
A proactive approach to process
improvement should be implemented to continually assess for
health IT-related patient safety risks.
This approach includes comprehensive testing of health IT hardware
and software to ensure that its free
from malfunctions; configuring the
system to allow clinicians to clearly
identify patients and maximize use
of the EHR to prescribe medications, tests, and procedures; and
providing patients with access to
their electronic records via portals
to enable them to review those
records for accuracy. For example,
organizations participating in the
OpenNotes project are seeing
improvements in quality and
safety over the 5 years of the study,
including enhanced error reporting,
more effective catching of medication errors, and improved care
coordination.3
Additional actions suggested by
The Joint Commission to reduce
risks emphasize the importance of
leadership and oversight of health
IT planning, implementation, and
evaluation. This oversight involves
examining workflow processes for
inefficiencies, choosing and optimizing systems that align with the
work of clinicians, continually
improving system interoperability,
and monitoring system effectiveness
according to established metrics.
But the ultimate responsibility for
minimizing the potential negative
impact of health IT lies with the end
users who should be aware of
potential risks to patients in any
clinical situation.
Another resource that offers a
plan for protecting patient safety
and improving care quality is the
recently published Office of the
National Coordinator for Health
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Information Technologys Health IT

Safety Center Roadmap.4 Central to
the proposal is creating a health IT
safety center or collaboratory that
welcomes stakeholders from across
the healthcare spectrum and government into a trusted space for collaborating on solutions. This center will
provide a forum for the exchange of
ideas and information focused on
promoting health IT as an integral
part of patient safety and carry out
the following activities:

rity failure due to incorrect or missing data in EHRs and other health IT
systems. Examples of data integrity
failures as listed in the ECRI Top 10
Health Technology Hazards for 2015
report include the following:
appearance of one patients data
in another patients record
missing data or delayed data
delivery
clock synchronization errors
between medical devices and IT
systems

The ultimate responsibility for minimizing the potential

negative impact of health IT lies with the end users who should
be aware of potential risks to patients in any clinical situation.
collaborate on solutions to address
health IT-related safety events and
hazards
improve identification and sharing
of information on health IT-related
safety issues
report evidence on health
IT-related safety solutions
promote health IT-related safety
education and competency.
The center will also play an
important role in gathering and
analyzing evidence for preventing
low-frequency, high-severity events,
such as wrong-site surgery, in which
the stakes are high but the causes
are poorly understood.
Several healthcare technologies
used daily by nurses are identified as
potential areas of risk by two reports
published by the ECRI Institute.5 The
top two hazards in each of these
reports were 1) alarm hazards due to
inadequate alarm configuration policies and practices and 2) data integ-

default values being used by

mistake or fields being prepopulated with erroneous data
inconsistencies in patient information when both paper and electronic
records are used
outdated information being copied and pasted into a new report.6
To address these problems, organizations should assess their health
IT systems and identify data integrity failures, correcting them to prevent similar problems from recurring. Organizations should also
empower users to report all types of
health IT-related incidents, including
those that dont cause any harm and
near-misses, because staff members
dont always recognize health ITs
contribution to an event. Nurses
should be especially mindful of the
risks of copying and pasting information from one episode of care to
another. When errors in documentation are made, incomplete, inaccurate,

Nursing Management November 2015 25

Copyright 2015 Wolters Kluwer Health, Inc. All rights reserved.

Safety solutions
or out-of-date information can end up
in a patients record, potentially leading to incorrect treatment decisions or
ultimately causing patient harm.

Where will technology take us?

It has been projected that by 2020 the
average household will contain several hundred smart objects, including
LED light bulbs, domestic appliances, sports equipment, and medical devices. These smart objects are a
part of the Internet of Things and
most of them will be able to communicate with an app on a smartphone
or tablet. Although its appealing to
anticipate having dinner prepared
by our smart appliances, we can also
imagine the impact these innovations will have on healthcare.
Monitoring data from a patients
wearable technology or maintaining
an accurate up-to-date inventory of
the right supplies and equipment
will allow healthcare organizations to
stay ahead of the curve. Implementing innovative solutions that capture
and analyze data in real time can
improve healthcare quality by finding common patterns and anticipating
outcomes. With smart technologies
rapidly maturing, the healthcare
industry stands to benefit from this
enhanced intelligence to improve
performance through innovation.
Another emerging technology is
remote patient monitoring, which
merges wireless technology and
healthcare to focus on chronic conditions such as heart disease and diabetes. Some healthcare providers are
installing devices in patients homes
to collect continuous data on weight,
BP, blood glucose, and blood oxygen
levels. These integrated systems
can allow providers to detect and
address issues before they have
serious health consequences. The use
of technologies, such as wearables,
telehealth, text messaging, and smart

devices, can potentially help reduce

rehospitalizations and promote prevention, allowing for earlier diagnosis and intervention.7 The challenge
for nurses is to ensure that we maintain a meaningful provider-patient
relationship while leveraging the
power of high-tech monitoring and
treatment approaches.
Although these emerging and
innovative technologies may
improve health and healthcare, they
can also introduce new security vulnerabilities.8 During a recent hearing,
lawmakers heard testimony from
industry leaders about both the benefits and risks to consumers of connected health devices that may hold
large amounts of personal health
information.9 Individuals looking to
exploit this valuable health data can
hack into these systems, cutting to
the very core of personal privacy.
Cybersecurity protections are rapidly becoming essential safeguards
for EHRs that are connected with
mobile devices.6 Acknowledging that
mobile devices are increasingly
being used to store, process, and
transmit patient information, the
National Cybersecurity Center of
Excellence has developed resources
to help organizations implement
advanced technologies to ensure the
security of patient information transmitted on such devices.10 Organizations can use these resources to
implement relevant standards and
best practices to minimize vulnerability to attack. These guidelines
should be used as part of a continuous risk management process that
will increase the security of EHRs.

Safe and secure

The role of todays nurse in safeguarding patient care is increasingly
complex. Understanding the potential risks of health IT and mobile
technologies, as well as adopting

26 November 2015 Nursing Management

Informatics

essential safeguards, will ensure

that care isnt compromised and
errors are mitigated. Resources are
available to equip nurses to navigate this evolving frontier, ensuring
patient safety and high-quality,
coordinated care. NM
REFERENCES
1. Agency for Healthcare Research and Quality. Chartbook on care coordination. www.
ahrq.gov/research/findings/nhqrdr/2014
chartbooks/carecoordination/index.html.
2. The Joint Commission. Sentinel event alert,
issue 54. www.jointcommission.org/assets/
1/18/SEA_54.pdf.
3. Miliard M. OpenNotes showing benefits at
BIDMC. www.healthcareitnews.com/print/
95681.
4. Office of the National Coordinator for
Health Information Technology. Health
IT safety center roadmap. www.healthit
safety.org.
5. ECRI Institute. Top 10 patient safety
concerns for 2015. www.ecri.org/Patient
SafetyTop10.
6. ECRI Institute. Top 10 health technology
hazards for 2015. www.ecri.org/2015
hazards.
7. Blumenthal S, Somashekar G. Advancing
health with information technology in the
21st century. www.huffingtonpost.com/
susan-blumenthal/advancing-health-withinf_b_7968190.html.
8. Slabodkin G. Connected health devices
generate innovation and consternation.
www.healthdatamanagement.com/news/
Connected-Health-Devices-Generate-Innovation-and-Consternation-51024-1.html.
9. U.S. House of Representatives Judiciary
Committee. Hearing: internet of things.
http://judiciary.house.gov/index.cfm/
2015/7/hearing-internet-of-things.
10. National Cybersecurity Center of Excellence. Securing electronic health records
on mobile devices. https://nccoe.nist.gov/
sites/default/files/nccoe/NIST_SP18001b_Draft_HIT_Mobile_Approach-ArchSecurity.pdf.
Joyce Sensmeier is the vice president of
Informatics at the Healthcare Information and
Management Systems Society in Chicago, Ill.
The author has disclosed that she has no
financial relationships related to this article.
DOI-10.1097/01.NUMA.0000472765.03731.28

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Copyright 2015 Wolters Kluwer Health, Inc. All rights reserved.