The nurse in Dallas that “did not tell” her fellow workers that the Ebola patient had been to Liberia left me totally astounded as to her incompetence — until this morning’s issue of Out Patient Surgery Magazine that announced the truth. She was not necessarily at fault — it was the electronic medical record (the system that is supposed to make healthcare safer?)
OPSM quotes hospital sources that indicated the nurse entered the information in the nursing screens, but based on the programmed workflows, the information did not populate to the physician’s screens. The system has been reprogrammed to post travel history to the physician screens with an alert for specific travel histories (such as West Africa).
Whether it is a programming error or a system design error or an intentional choice of what doctors wanted to have on their screens, this is a dramatic example of how different screen views can be a barrier to proper care and a liability risk. Adding an alert as an extra precaution is probably a good idea, but industry media is increasingly reporting on alert fatigue and the development of a tendency by physicians to reflexively over-ride alarms.
As an additional risk precaution, facilities might consider the “old school” approach and have nursing staff TALK TO THE PHYSICIAN when something of potential concern comes up. Information systems should not reduce communication or else screw-ups and liability will follow.