​More than one-third of medication events in intensive care units (ICUs) may be related to the electronic health record (EHR), with the majority coming in the ordering phase, according to a study published in the January 2017 Journal of Healthcare Risk Management. The authors assessed whether the EHR was related to 1,622 potentially preventable adverse drug events (ADEs) that impacted 624 patients at two ICUs at a large medical center. They found that 34% of medication events were related to the EHR. EHR-related events were also found to be more likely related to serious patient harms than non-EHR related events. A higher percentage of EHR-related events occurred in the ordering stage than non-EHR events. For example duplicate information accounted for 17% of the 551 EHR-related errors, compared with 7% of the 1,071 non-EHR errors. Although 40% of EHR-related medication errors occurred during administration, the authors said many of these errors had their genesis in the ordering phase. The authors also analyzed the four questions used to determine EHR readiness: Is there direct evidence in the literature for this type of error being EHR-related; is there a possible mechanism for this error being EHR-related; could this error have been prevented with a technology redesign; and are there other, non-EHR factors that could explain the error? Their analysis found that the first two questions (evidence-based literature and an EHR-related mechanism for the error) explained the majority of EHR-related outcomes. Future research should focus on whether these two questions alone may be suitable to characterize the impact the EHR had, the authors said. The article included a list of all the EHR-related medication events encountered during the study, which the authors said healthcare organizations could use to monitor potential patient safety problems.

HRC Recommends: Risk managers should review the study and ensure that staff are aware of these potential errors. Initial steps toward improvement include heightening awareness of the problem and improving training in medication safety as it relates to the EHR. Healthcare organizations should encourage staff to report near-misses as well as events that reach a patient, to develop a more complete understanding of their organization's vulnerabilities.