In the case study, the hospital’s eMAR shortened the morphine orders display, not indicating whether the drug is for continuous-release for long-term pain relief or an instant release. It lead to a cancer patient being given both formulations of morphine at once, causing the patient to suffer a respiratory arrest which can cause a severe health risk (Pereira, Ahn, Han, & Abourizk, 2018). The incident was due to the human-computer issue of retrieving the wrong data of drugs as both had the same name of morphines. Still, the user did not differentiate between morphine for long-term pain and morphine for short-term pain, giving the patient both medications.

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