Healthcare News & Insights

EHR changes reduced ordering errors for NICU patients

Errors in patients’ clinical orders could have serious consequences. But a few simple tweaks to one hospital’s electronic health records (EHR) system managed to cut these mistakes for a group of vulnerable patients: babies in the neonatal intensive care unit (NICU).

78751261Like many hospitals, Montefiore Medical Center would identify newborn NICU patients who weren’t yet named using the temporary names “BabyBoy” or “BabyGirl.” And this led to a lot of confusion, as described in an article from MedPage Today, including many near-miss errors involving clinical orders.

In the past, Montefiore had updated its EHR to track how many near-miss wrong patient orders happened for NICU patients. Hospital researchers built a feature into the EHR called the Retract-and-Reorder (RNR) mechanism. The feature alerted them when a doctor put in an order for one patient, then canceled it quickly and put in the same order for another.

The rates for these near-miss instances were higher among patients in the NICU than others – and several of them were considered life-threatening.

Stopping mistaken identity

Researchers decided to test whether adding an identity verification feature into the hospital’s EHR would reduce issues with orders being entered for the wrong patient. With the feature, a pop-up window prompted providers to enter each patient’s initials, gender and age before placing any orders.

After implementing this feature, researchers examined whether it affected the rate of RNRs for NICU patients, and they found it reduced them by over 50%. In fact, near-miss orders decreased so sharply, they ended up happening less often than they did in the non-neonate patient population.

Then, Montefiore took it a step further. Not only did the hospital require identity verification when placing patient orders, it also gave each unnamed NICU patient a unique first name generated automatically by the EHR, instead of using just “BabyBoy” and “BabyGirl” for each.

The system would randomly combine a number, the mother’s first name, the letter “s” and the baby’s gender to create a identifier for each child.

When comparing near-miss error rates for patients before this extra layer of identification was added, the new naming system reduced errors with individual patient orders by almost 50%.

Importance of double-checking

Any error with a patient’s medication, lab tests or treatment could not only negatively affect the person’s recovery, it could also come back to haunt a hospital. So it’s crucial for hospitals to put measures in place to make sure all clinical orders are going to the right patients the first time around.

With that in mind, hospital execs may want to talk to their IT departments or EHR vendors to see it’s possible to put mechanisms in place to track near-misses with patient orders or to add in an extra layer of patient identity verification.

These changes could be helpful in keeping patients safe from preventable harms in all departments of your hospital – not just the NICU.

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