Requests about patient end-of-life preferences are sometimes not followed because providers can’t find the instructions in their electronic health records, according to a recent StarTribune article.
While EHRs can store advance directives, such instructions are not consistently in one place; sometimes, they’re stored in more than one location.
In one situation highlighted by the StarTribune, a patient with a tumor who filled out a Provider Order for Life Sustaining Treatment (POLST) and added it to her EHR ended up in her hospital’s emergency department with cardiac arrest. Although the POLST said that the patient should not be resuscitated in the event of cardiac arrest, she was resuscitated anyway because the POLST could not be found in the EHR. It turns out that the patient was treated in the emergency department by a physician who had missed training on where advance directives documents were located. They originally were placed in a file under “administrative” and then moved to a file named “media.”
“It is critical that all of our clinicians know where to look and that process is simple and quick,” Tom Von Sternberg, senior medical director at HealthPartners, which operates the hospital where the incident occurred, told the StarTribune. “We failed to do that for this patient."
There are some exceptions, according to the article. For instance, Gunderson Lutheran Medical Center, in La Crosse, Wisconsin, which has been very active in encouraging residents to complete advance directives, made it a point when adopting an EHR in 2008 to work with its vendor to make end-of-life instructions easy to find. They added a banner that includes a tab on every page for clinicians who are looking for this information.
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