The promise of technology and its use in medicine is highlighted as a hallmark of a progressive future in healthcare defined by a variety of positive outcomes like reduced errors and costs, early diagnosis and treatment of illnesses as well as improved overall patient care quality. However, it is also acknowledged that utilization of health information technology (HIT) is accompanied by a variety of side effects including documentation errors, system malfunction and adverse patient events, among others (Dimick, 2014). The two main types of HIT-related incidents include those that are computer-related and those that are human-computer related where the latter involves errors made by users during system use while the former denotes problems with hardware and software (Wallace et al., 2013).
The case study ‘Health IT Event Report Leads to Safety Improvements’, presented by the authors’ highlights a computer-specific, HIT-related incident where information on a cancer patient medication was not displayed properly/fully in the system. Specifically, display of medication prescribed was cut off, with no clear indication of the specific medication provided; which was to be extended-release morphine for every 12 hours as well as smaller doses of immediate-release formulation as needed for breakthrough pain (Wallace et al., 2013). The cut off, which displayed a general prescription of morphine, led to the erroneous provision of the two formulations concurrently leading to adverse patient outcomes, even though the event was reported, reviewed and corrected for accurate displays of dosing information in the future.
The adverse patient outcome in this case involved respiratory arrest due to the morphine overdose even though the patient was successfully intubated and resuscitated which preempted patient death as the ultimate potential consequence of the HIT error. Despite the seriousness of the consequences, Magrabi et al. (2010) indicates that such computer-specific HIT-related incidents make up only 0.2 percent of reported HIT incidents. The reporting, review and correction of such events provides a chance for reduced adverse outcomes; a necessity in designing, fostering and nurturing a culture of safety which can be inculcated through the efforts of competent nurse leaders despite various challenges (Piersma, 2015).
The specific activities that can be engaged in by nurse leaders in establishing a culture of safety related to HIT includes education of staff about HIT safety, advocacy of HIT safety as everyone’s responsibility and promotion of open communication about HIT safety concerns (Wallace et al., 2013). Others include staff empowerment in relation to identification, reporting and amelioration of HIT system-related risks and hazards, establishing a blame-free environment for reporting HIT-related problems without fear of reprisal or punishment as well as adequate resource allocation necessary to ensure HIT safety. These activities should be part of general activities initiated towards establishing a culture of safety where healthcare leaders including nurses are identified as critical to team/organizational success through creation of positive work environments, learning culture and change management (Ring and Fairchild, 2013).