Every year, millions of people aged 65 and over fall. According to the Centers for Disease Control and Prevention (CDC), 3 million seniors are treated in emergency rooms each year for fall-related injuries and more than 800,000 patients a year are hospitalized for a fall-related injury. 13. Oliver D, Connelly JB, Victor CR, et al. Strategies for the prevention of falls and fractures in hospitals and nursing homes and effects of cognitive impairment: systematic review and meta-analyses. 2006 Bmj;334:82. [to PubMed] The current and potential positive effects of the EHR on quality of care are undisputed. However, ethical issues related to the predominance of institutional priorities over patient-centred practice and independent care, driven by the application of decision support, clinical practice models, and/or clinical practice guidelines (CPMs), have been documented (Lown & Rodriguez, 2012; McBride, Tietze, Hanley & Thomas, 2015; Sulmasy, López, & Horwitch, 2017). Perhaps the most troubling ethical issue is the possible erosion of the patient-nurse relationship (de Ruiter, Liaschenko, & Angus, 2016; Rathert, Mittler, Banerjee, & McDaniel, 2016). We conclude with a call to action to interprofessional teams, associations, industry and others to address these issues together on behalf of the health and safety of the nation and equally important to the health and well-being of health care workers. To this end, the authors suggest the following recommendations to address EHR challenges. These recommendations can help mitigate ethical and legal issues arising from the mass adoption of technology that has led to the digital age of healthcare.

Kalra, J., Kalra, N. and Baniak, N. (2013). Medical errors, disclosure and patient safety: a global vision of quality of care. Clinical Biochemistry, 46, 1161-1169. doi: 10.1016/j.clinbiochem.2013.03.025. Sometimes I feel like the medication administration barcode scanning system hinders critical thinking and prevents you from really looking at what you`re giving the patient. This report presents various aspects of patient safety with respect to root cause analysis (CRA) and risk management, the role of human resources, the role of professionalism, the need to inform parents (disclosure of medical errors) and forensic pathology with a focus on ethical aspects. The stress Nancy feels in the emergency room scenario is an example of this kind of moral distress.

Specific issues reflected in the case scenario and identified in the qualitative review by Wolf and colleagues (2016) relate to moral burdens due to overemphasis on documentation, tasks and measures at the expense of patient care, as well as role conflicts arising from hierarchical decisions. The same problems are reflected in a number of comments in Table 1 (e.g. Too much emphasis on documentation and measurement, resulting in inefficiencies and distraction from patient care). These symptoms trigger the CDS EHR warning for sepsis because the patient scored high on the hospital`s sepsis screening tool built into the EHR. The CDS triggers alarms prompting the prescribing physician to resuscitate the patient with fluid according to Center for Disease Control guidelines in case of suspected sepsis. Nancy acknowledges that not only does this patient have symptoms that could develop sepsis, but the EHR states that the patient has previously been admitted for heart failure (HF). She suspects that the feverish patient does not have sepsis, but rather has an exacerbation of HF with possible pulmonary edema, as the patient also has 2+ bite edema and crackling in both lung bases. Alerts can present challenges for clinical decision-making. One of the strengths of certified EHRs under the HITECH Act of 2009 to support patient safety and quality is that evidence-based protocols can be reinforced by clinical decision support (CDS). The CNS is designed to trigger or alert the clinical team with the right information through the right channels to the right person at the right time, for the right patient, the right EHR or assistive technology pathway (Osheroff et al., 2012).

These same caveats can present clinical teams working with a real patient with clinical decision-making challenges and raise practical and ethical considerations. Patients have the right to choose to participate in care processes. Nurses express concern and frustration about patients who do not call for help even after repeated instructions and then fall. These patients may qualify as “non-compliant”, but are they really non-compliant? In all health care facilities, nurses design and select fall prevention measures by checking a box in an electronic or paper record based on an assessment or fall risk level. This approach to falls prevention is one-sided, excludes patient participation and ignores respect for the patient who is educated and informed about decisions. If you have been through this experience and you know that some patients will exercise their right not to call for help, then a change in conversation and advice is necessary. Patients have the right to make choices, and health care providers are able to maximize patients` knowledge about the decisions and consequences of the available decisions, thereby ensuring informed choice. Patient safety laws and regulations, which may vary depending on each country`s legislative system, should encourage the disclosure of medical errors while supporting the implementation of ethical patient safety imperatives. In general, the negligent patient should be fairly compensated in accordance with medical law. In addition, these rules offer the opportunity to promote transparency and open communication at all levels.

To achieve this goal, all actors in the health system must be taken into account (21). In fact, an important ethical point in this case is the need to offer an honest apology. It`s not always easy to say, “We`re sorry.” How parents are informed is a sensitive issue, and there is an urgent need to train health care providers in sensitive interpersonal relationships and related skills to facilitate honest and appropriate communication with the patient`s family (20). In addition, training and emphasis on the Code of Conduct can be effective in deepening understanding and belief in the moral foundations of patient safety. Many potential and actual medical errors are part of nursing practice (Lachman, 2007). Therefore, nurses have an ethical obligation to avoid and treat medical errors. The rest of this column discusses ethical principles regarding medical errors that caregivers should consider, as well as recommendations that can help shape a safety culture to prevent medical errors. [Nancy] feels very desperate, but hopes for the best outcome for this patient. No orders for a slow infusion were found in the EHR, with only verbal instruction to a busy ED shift for a patient ready to be transferred to the intensive care unit. Nancy questions the appropriateness of the doctor`s orders, but follows the doctor`s instructions. She feels very desperate, but hopes for the best outcome for this patient. She then signals the physician`s request to drain slowly during an oral transfer to the intensive care nurse who sees the patient.

The intensive care unit nurse detects that the infusion is not following the registered EHR order and opens the infusion according to the computer vendor prescription (CPOE) entry. The patient has respiratory arrest. The patient requires intubation due to flash pulmonary oedema followed by a diagnosis of acute occurrence of exacerbated fluid overload, secondary to rapid administration of an intravenous (IV) fluid bolus and complication of HF. The attending physician in intensive care determines that the patient does not have sepsis. 5. Schwendimann R, Bühler H, De Geest S, Milisen K. Falls and aftermath: effects of an interdisciplinary fall prevention program. BMC Health Serv Res. 2006;6:69. [to PubMed] Undoubtedly, nurses ask patients (and caregivers) to call for help and why it`s important, but discussing the decision not to call for help is rarely part of the discussion. Rarely, this option is found in a patient education program, brochure, brochure, or medical record training checklist.

Nevertheless, let us focus on the right to choose, not to call for help. I have been in the care business for about 25 years, in recent years I have heard that a patient has the right to fall. My question is how the patient has the right to fall and is it a law that he has this right? This case represents a scenario that is happening across the country in terms of EHR-triggered protocols that capture electronic quality measures that are often linked to value-based purchasing payer models where the organization is penalized if the measures are not met.