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Ask the Expert: When going electronic, beware of unforeseen issues

Accreditation Connection, June 27, 2005

Although switching to CPOE is supposed to help organizations decrease errors caused by illegible handwriting, it can actually create new problems, says Cathie Abrahamsen, RN, MSN, owner of HealthWorks Consulting Associates in Palatine, IL.

Beware of 'work-arounds'

A work-around-when clinicians try to side-step a computer function due to time constraints or unfamiliarity with the system-can lead to new quality and safety issues that organizations don't anticipate.

"Systems don't take into account the healthcare professional's work atmosphere," says Abrahamsen. "Inventors designed most systems for people who work in calm, solitary environments rather than in an atmosphere of frequent interruption by phone calls, patients, or coworkers."

Understandably, these design flaws make some physicians reluctant to embrace CPOE systems. "I've met some physicians who are leaving their hospital practice because they're uncomfortable using an electronic system," she says.

Computer entry: The fourth leading cause of medication errors

Computer entry was the fourth overall cause of medication errors in 2002, with 17,998 errors recorded, according to the U.S. Pharmacopeia (USP).

System design is one reason for errors. For example, a prescriber may confuse James Brown Sr. with James Brown Jr., because there is no distinction between each row on the computer screen.

"The prescriber is seeing one name on the screen, but the eye doesn't follow to that suffix," says Abrahamsen. "You need to make each line discernable by highlighting every other one."

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