Claim One An elderly female saw an otolaryngologist for ear/nose complaints. The physician intended to order Flonase nasal spray. The patient filled the prescription and took it as directed. Ten days later, she went to the ER for dizziness. Two weeks after that, the pharmacy sent a refill to the physician at his request. It was for Flomax — a medication prescribed for enlarged prostate — which has a side effect of hypotension. When ordering the prescription, the physician had typed “FLO” in the medication order screen. The EHR automatched Flomax, and the physician selected it without realizing the mistake. Flomax is not FDA-approved for females. There was no EHR Drug Alert available for gender. To prevent this type of mistake, the provider should have reviewed the prescription with the patient and read what was ordered. By writing the indication for the medication on the prescription, the pharmacist would have been alerted that the medication was not appropriate to the condition being treated.
Claim Two A dialysis patient was transferred to a skilled nursing facility. There was an active hospital transfer order for Lovenox. A physician evaluated the patient on admission but made no comment about the Lovenox order. During the first dialysis treatment, there was active bleeding at the fistula site. The anticoagulant heparin had not been given. The nursing staff did not inform the physician of the bleeding. During the second dialysis treatment, there was uncontrolled bleeding from the fistula, and the patient exsanguinated and expired. Experts were critical that there was no EHR high-risk medication alert. Medication reconciliation might have prevented this error. Strategies for Reducing Alert Hazards • Understand alarm fatigue. When caregivers become overwhelmed, distracted, or desensitized to an alarm or an alert, determine the most important alarms, and work with your vendor to ensure that unnecessary alarms or
alerts are not built into your system (5). • Determine if alerts are appropriately configured so that alert conditions are not missed or ignored (6). • Assess your EHR for frequent drugdrug interaction alerts, which have been shown to lead to alert fatigue that can cause the alerts to be disregarded, ignored, or disabled. Work with your EHR vendor to use key data elements to design EHR alerts for high-risk drugto-drug interactions. The result will be more meaningful alerts that are less likely to be ignored or disabled, thus avoiding a possible error. • Be aware that clicking through drugto-drug therapeutic duplicates or drug/ allergy alerts with little review can be interpreted to mean that the physician ignored the safety alerts. • Read the alerts. EHRs record how much time is spent reviewing information. If the time is very brief and there is a negative patient outcome, the physician could be perceived as sloppy or hurried.
PHYSICIANS NEEDED FOR GROWING TELEHEALTH MEDICAL GROUP! We are an established multidisciplinary medical group looking for additional physicians to join our team, especially telepsychiatrists! Telemedicine can fit into your schedule whether you have a busy practice or you’re just starting out. You decide the number of days/hours you want, and whether you work from the office or home. To learn more, contact us at 661-840-9270 or send your CV to jobs@telehealthdocs.com.
Seeking Family Medicine and Internal Medicine Physicians in San Diego, Riverside and Orange Counties Position: Full-time, part-time and per diem Family Medicine and Internal Medicine Physicians. Malpractice coverage is provided by clinic. Requirements: California license, DEA license, CPR certification and board certified in family medicine. Bilingual English/Spanish preferred. Send resume to: hr@vistacommunityclinic.org or fax to 760-414-3702
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Vista Community Clinic is a private, nonprofit outpatient community serving people who experience social, cultural or economic barriers to health care in a comprehensive, high quality setting.
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