Transcribing patient orders is one of the many documentation tasks that medical transcription companies help physicians with. Today, computerized physician order entry (CPOE) allows providers to transmit orders quickly via the electronic health record (EHR). While EHRs are designed to optimize work flow and communications and offer a way to document patient care accurately, wrong-patient orders continue to be a problem. According to a recent report published by Columbia University Irving Medical Center, there are about 600,000 wrong-patient orders every year. A wrong-patient order is when an order meant for one patient is issued for another patient. These “wrong-site, wrong-procedure, wrong-patient errors” (WSPEs) can cause serious harm and even prove fatal. The question is whether EHRs pose a high risk of wrong patient orders.
CPOE systems come with several high-end features (searchhealthit.techtarget.com):
- Ordering: Clinicians can enter physician orders into a workstation, laptop or secure mobile device instead of completing a paper chart.
- Patient-centered decision support: Integratingclinical decision support systems and EHRs will ensure up-to-date patient information and complete medical history, enabling better care decisions.
- Patient safety: CPOE allows healthcare providers to perform real-time patient identification, review medication dosage recommendations and screen for potentially adverse drug interaction as well as for patient allergies and treatment conflicts.
- Intuitive user interface: The order entry workflow can be easily managed by new or infrequent users.
- Regulatory compliance and security: CPOE systems ensure safety of access and information in compliance with state and federal guidelines.
- Portability: The software accepts and manages orders from all departments at the point of care through various devices.
- Management: Reports generated can be analyzed and evaluated, which helps improvements to be made if needed.
- Billing: Documentation and billing is improved.
CPOE can lead to Wrong Patient Orders
Several studies have found that wrong patient orders occur quite often with CPOE. The reason for this, according to an article in The Hospitalist is that “physicians toggle back and forth between screens in the system interface”, making data entry errors and placing wrong-patient orders. This leads CPOE systems to unintentionally cause errors.
According to arecent JAMA study by researchers at Columbia University Vagelos College of Physicians and Surgeons, the risk of wrong-patient orders was similar whether providers were allowed to have just one patient record open or multiple patient records open at the same time. The study covered 3,356 health care providers treating patients in the emergency department, hospital, or outpatient setting. Fifty percent of the participants were allowed to open up to four patient records at a time, while the rest could open only one record at a time.
On tracking the number of wrong-patient order sessions, the researchers found that the error rates of both groups were similar. However, providers in the hospital and emergency department used multiple records and made more errors than clinicians in outpatient settings who usually opened one record at a time. The team concluded that the environment played a role in causing errors. In a busy healthcare environment, clinicians tend to open multiple records as they care for multiple patients simultaneously, which could cause more errors.
Another study identified 644 probable wrong patient orders in a pediatric hospital (www.chpso.org). In most cases, the wrong order was quickly cancelled and replaced with the correct order for the correct patient. The researchers identified the risk factors for wrong patient orders as follows:
- Age: infants and newborns were much more likely (2.9 and 3.6 times, respectively) to have wrong-patient orders
- Last name: two-letter overlap 4.4 times more likely
- Location: patients in nearby rooms 2.8 times more likely
- Day of week: Friday 2 times more likely than Monday
- Hour of day: midnight to 6 am 1.7 times more likely than 6 pm to midnight
- More physicians ordering for the patient: 1.4 times more likely
Mitigation Strategies
Appropriate interventions can help lower the odds of wrong-patient errors.
- Automated verification systems (such as bar-coding technology) may help to reduce the chances of misidentifications for patients with similar names. A particular team member must be given the responsibility of matching the bar code on the patient’s identity bracelet to the bar code on the medication or surgery schedule.
- Implementing a patient verification alert can decrease the number of order retractions and re-orders due to wrong patient order entry in the emergency department setting.
- Using two patient identifiers when entering orders into EHRS, in compliance with the recommendations of the Joint Commission’s national patient safety goal (chpso.org).
- Patient ID verification alerts and patient photographs in EHRs
- Proper communication among physicians, nurses and others in the care team as well as communicating with patients.
- Provider training
- Limiting, when feasible, the list of available patient records for each provider
Outsourced medical transcription services can ensure accurate, well-formatted feeds in EHRS. Well-versed in drug names, medical conditions, and transcribing different accents and dialects, experienced medical transcriptionists can correctly document physicians’ verbal orders. It is up to healthcare providers to follow best practices when maintaining orders to promote patient safety.
