Validation for Newly Implemented Electronic Medical Record Chemotherapy Power Plans

Electronic Medical Records (EMRs) were made with the intention of increasing patient safety and improving the quality of care one receives. Unfortunately, this has not been the case with Electronic Medical Records. The EMR actually increases the risk of medical errors in the first two years after implementation. The increase in errors may be due to many factors, but because of the trends seen in research after EMR initiation, the National Quality Forum has requested the development of processes to help increase patient safety after implementation. In a community-based hospital for hematologic malignancies, within the Salt Lake Region, a validation team was constructed to test Power Plans. A Quality Assurance physician, Quality Assurance coordinator, and Nurse Practitioner student used current chemotherapy order sets and performed the Failures Modes and Effects Analysis on each set. The analysis was then utilized to construct a validation process and checklists for the chemotherapy Power Plans and workflow. The validation team was educated by the validation experts to the validation process and checklist and then the top five Power Plans were tested by the team. Of the thirteen Power Plans that were validated, eleven passed and two had severe failures for an overall pass rate of 84.6 percent. The validation process was successful in recognizing failures within the EMR and workflow process. Failures captured during this validation process may have resulted in severe failure that caused patient harm or even death if not addressed. These failures included: dosing of chemotherapy, timing of medications, and having no Body Surface Area (BSA) calculator in the Electronic Medical Record. At the end of the project, all failures had been resolved which ultimately will increase patient safety in the ordering process for future use in the live patient environment.