Monday, 15 July 2013

Liverpool Care Pathway - Patient Safety: Recognising Euthanasia

Over-sedation is the least-recognized error (16%)...
Euthanasia is euthanasia is euthanasia.

This is Healthcare Informatics 

Healthcare Informatics
On July 1, the Department of Health & Human Services unveiled a patient safety plan in response to calls for health IT to play a greater role in reducing medical errors. Central to the effort is the push to establish mechanisms that facilitate incident reporting among users and developers of health IT.

Jeffrey Gold, M.D., a pulmonary critical care physician scientist at Oregon Health & Science University (OHSU) in Portland, is studying the role of simulation in improving usability of EHRs and is working toward integrating EHR simulation into residency and fellowship training.

Gold and his colleagues recently published a paper in the journal BMJ Open on a pilot project they ran in which they created a five-day simulated ICU patient in the Epic EHR including labs, hourly vitals, medication administration, ventilator settings, nursing and notes. Fourteen medical issues requiring recognition and subsequent changes in management were included. Issues were chosen based on their frequency of occurrence within the ICU and their ability to test different aspects of the EHR user interface. ICU residents, blinded to the presence of medical errors within the case, were provided a sign-out and given 10 minutes to review the case in the EHR. They then presented the case with their management suggestions to an attending physician. Participants were graded on the number of issues identified. All participants were provided with immediate feedback upon completion of the simulation.

“When talking about patient safety, people often make reference to flight simulators. Well, with those you respond to dangerous situations,” he said. Pilots are not just shown obvious things like two engines fell off or you took off with no fuel. It is more subtle things like you are gradually losing altitude at a slow but constant rate, and can you notice that. EHR simulation has to have that same fidelity to the subtle nuances of the clinical setting, he added.

Of the 38 participants, including 9 interns, 10 residents and 19 fellows, the average error recognition rate was 41%. Over-sedation was the least-recognized error (16%)...


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