Patient Photo on Health Record Curtails Medication Errors

Ingrid Hein

November 26, 2019

The idea is simple — display a photo at the top of an electronic health record, visible at all times, alongside the patient's name, age, and medical record number — and physicians are less likely to make "wrong patient" medication errors.

"Errors commonly occur when the provider is interrupted during order entry and has to multitask between multiple patient's charts, or when the provider uses a patient list and selects the wrong patient by accident," the researchers — Bonnie Blanchfield, ScD; Adam Landman, MD; and Hojjat Salmasian, MD, PhD — from Brigham and Women's Hospital in Boston, explained.

"Other groups have implemented strategies to reduce wrong-patient errors that have involved interruptive solutions," such as alerts, but adding a photo "is noninterruptive yet significantly effective," they told Medscape Medical News.

In their pilot study conducted in the emergency department of a large urban academic medical center, registration staff took photos of consenting patients when they checked in.

The team then assessed orders placed using electronic health records — 213,643 with a photo and 996,223 without (18% vs 82%). The study findings were presented at the American College of Emergency Physicians 2019 Scientific Assembly in Denver.

Because the researchers could not measure actual errors, they looked at potential errors using a tool that detects retract-and-reorder events, which has previously been shown to be effective in the identification of wrong-patient electronic orders.

With the retract-and-reorder tool, they could see "near-miss events," in which a physician retracts an order and then applies the same order to another patient within a 10-minute timeframe.

During the study period, the researchers identified 312 retract-and-reorder events.

Such events were more frequent in records without a photo than with a photo (relative risk, 0.625; P = .0025).

Table. Retract-and-Reorders During the 18-Month Study Period
Retract-and-Reorder Events No Photo Photo Total
Number 275 37 312
Rate per 100,000 orders 27.6 17.2 25.7

"These events occurred, but there could be other events that were not caught," the researchers acknowledged.

"We know that medical errors are pretty common," said Joseph Piktel, MD, from the MetroHealth Medical Center in Cleveland.

"As a physician, you're flipping through patients quickly," he told Medscape Medical News.

There are many reasons an error can occur, and this study only assessed rates, not causes. However, interruptions likely play a role in the occurrence of wrong-patient order-entry errors.

"Future work should focus on understanding the types and causes of interruptions and solutions to reduce them, especially at sensitive times, like during order entry," the researchers explained.

But errors can also be related to clicking mistakes, a provider not logging out of the system after using it, the transposition of medical record numbers, and the misreading of information because the font is too small, according to a study of the problem.

Patient photos continue to be taken at Brigham and Women's, and the researchers said they hope to expand the program so that they have sufficient data to back up policy decisions about patient photos.

"We know, for instance, that not all patient populations will benefit from photos, and they may not be useful or effective for neonates and infants," they pointed out.

The team is also planning to study how the design of the electronic health records system itself might contribute to order-entry errors.

American College of Emergency Physicians (ACEP) 2019 Scientific Assembly.

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