Nurses Raise Alarm Over Epic-Related Safety Errors

Posted on August 20, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

EMR transitions are difficult — if not excruciating — for just about every hospital that undertakes them. But one Epic installation at a California hospital seems to be having more than its share of problems, to the point where a med administration recommendation allegedly could have killed a patient.

Recently, nurses at at the prison clinic run by the facility, Contra Costa County Hospital, were about to give a dose of heart medication to an inmate as recommended by the EpicCare system.  Unfortunately, the dose recommended by the EMR might have killed the patient, say the nurses involved.  One nurse caught the error and adjusted the dose before the inmate received the potentially fatal dose.

These nurses are so concerned about the system, which, according to nurse Lee Ann Fagan, won’t let them document medication administration properly, that they’ve gone the county board of supervisors which oversees the hospital’s operations.

According to Jerry Fillingim, a labor representative for the California Nurses Association, “the Epic system decision support technology interferes with the RN’s duty and right to advocate in exclusive interest of their patients,” reported HealthLeaders Media.

Anna Roth, RN, CEO of hospital operator Contra Costa Health Services, told the board of supervisors that the 164-bed county hospital and ambulatory services had just switched to Epic on July 1st, and that the hospital had prepared well in advance for the workflow changes EpicCare would bring.

Nurses don’t seem to agree. According to HealthLeaders, 142 nurses have filed complaints with the labor union, many of which allude to their getting inadequate or incomplete training.

Other executives told Health Leaders that fixes have been made to the system since the go-live date, but that some of those fixes hadn’t been communicated adequately to some staff members.  OK, that may be true, but if the system’s churning out dosing information which is just dead wrong, giving nurses the 411 won’t solve the problem by itself.

Wow.  Just wow. I obviously don’t know how well this county hospital has been run historically, but I’d definitely question whether the workflow planning was all that robust or training even close to adequate.  Meanwhile, I have to wonder what EMR they dumped to bring in a multi-million dollar EpicCare install, and why. Could things have actually been worse before?