BEUDAMED
    FDA Adverse Event Injury Summary report: N

    EPIC CPOE

    MDR report key: 6964415 · Received October 20, 2017

    Report

    Report Number
    MW5072855
    Event Type
    Injury
    Date Received
    October 20, 2017
    Date of Event
    October 16, 2017
    Report Date
    October 17, 2017
    Manufacturer
    EPIC
    Product Code
    OUG
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    PA, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    THE REPORT EXEMPLIFIES WIDESPREAD (ACROSS SEVERAL HOSPITALS AND MANY PTS) TOXICITY CAUSED BY A CPOE (ORDER ENTRY), AND EHR (CARE RECORD) DEVICE IN WHICH THE TESTS, MEDICATIONS, AND TREATMENTS THAT ARE ORDERED ARE NOT DONE IN A TIMELY MANNER, IF AT ALL. IN THIS CASE, THERE ARE SEVERE OBSTRUCTIVE CORONARY DISEASE. A TROPONIN BLOOD TEST WAS ORDERED TO EVALUATE FOR MYOCARDIAL INFARCTION, ON MORE THAN ONE OCCASION. THE ANCILLARY SERVICE RECIPIENT DID NOT CARRY OUT THE ORDER BECAUSE IT EITHER NEVER GOT THERE, WAS NOT SEEN, OR OTHER. THERE IS NOT ANY RECONCILIATION FUNCTION TO WARN THAT TESTS AND MORE HAVE NOT BEEN DONE. WITHOUT KNOWING THAT THE PT HAD A MYOCARDIAL INFARCTION IN A TIMELY MANNER, THE CORRECT TREATMENT CANNOT BE CARRIED OUT. THIS IS POTENTIALLY LIFE THREATENING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    743998 EPIC CPOE CPOE/EHR COMPUTERIZED PHYSICIAN ENTRY OUG EPIC
    743999 MDDS DEVICE MDDS OUG EPIC

    Patients

    Seq Age Sex Outcome Treatment
    1 82 YR Hospitalization| L| O