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March 2019

Editor’s Note: Charting Ethics
By Lee DeOrio
For The Record
Vol. 31 No. 3 P. 4

As anyone who attended HIMSS19 in Orlando can tell you, the number of educational opportunities presented to attendees was staggering. From traditional sessions in conference rooms to “rapid fire” tutorials held on the exhibit floor, there was no shortage of selections from which to choose. As a result, deciding when and where to go was never more challenging.

After an unfruitful search of exhibitor booths for technology that allowed me to be two places at once (there seemed to be a solution for everything, so why not that?), I set a path forward for what I thought would be the most compelling conversations. I’m pleased to report there were more hits than misses.

Ranking near the top of the heap was “Moral Distress With Burden of Documentation: Call to Action,” a session delivered by Susan McBride, PhD, RN-BC, CPHIMS, FAAN, a nursing informaticist at Texas Tech University Health Sciences Center. An engaging host, McBride strongly encouraged audience participation at any point during her presentation and left ample time for attendees to share their experiences, many of which complemented her thoughts.

McBride used real-life cases and research to illustrate how documentation practices in EHRs have raised ethical concerns. She cited a case in which a patient’s condition triggers an EHR alert for sepsis although the nurse notices that the patient had been previously admitted for heart failure. Nevertheless, the physician, out of fear of failing to follow protocol, orders a slow drip, which the nurse believes to be unnecessary.

Disaster strikes later on when the ICU nurse, recognizing that the drip does not follow the EHR-recorded order, opens up the drip.

McBride emphasized this situation as an example of what can occur when EHR-triggered protocols that capture electronic quality measures are tied to value-based purchasing payer models. To avoid such situations, she recommended clinical teams use critical thinking skills when presented with information originating from the EHR that does not jibe with their best judgment.

This raised a larger question of what types of information must be included in the EHR. The audience offered a wealth of ideas and approaches to better documentation, including the Kaizen method, disallowing the placement of any audit information in the chart, accounting for possible secondary uses, and encouraging a team concept centered on collaboration.

There was consensus on one point: A strong ethical core is essential.