Doctor texting order turned into a nightmare

[Scotthudson1966]

I work in a sub acute care facility and we don't always have a doctor in house. Most of the doctors and nurse practitioners are texting orders to the nurses. We are also texting questions and lab information to the mds and nps.

Today I had a patient with a blood sugar of 600 and paged the doctor and did not get a reply so I texted the doctor And she texted me back stating to get stat labs give additional insulin etc then she proceeded to text orders for three other patients. Med changes and other labs etc. in the middle of her texts she decided to send the patient to the ER after stating to wait for stat labs since the patient was asymptomatic.

Somehow I missed the text send to ER, so when the next shift took over I told the on coming nurse to be on the look out for the stat lab results and call MD as soon as they arrive. The labs arrived and when he called the doctor she flipped out saying she gave orders to send mr X to ER And she told the other nurse she is going to sink my ship so to speak for not following orders.

I'm sure anyone reading this can see so many wrongs here. Thinking from now on no more texting with doctors. Anyone have any similar situation or thoughts on this issue ?

[imintrouble, BSN, RN]

I saw a newer nurse where I work text an MD for orders. The first time I've ever seen any nurse do that. Didn't even know it was being done til right now. My thought was it's just unprofessional. I have been enlightened. I'll add HIPAA violation to why I don't like it.

I'm such a dinosaur

[BSNbeauty, BSN, RN]

I worked at a place that used yahoo email to communicate with docs. Orders were communicated as well. The nurses would print the emails and put them in charts. I was appalled . Email accounts get hacked into all the time. I couldn't trust that the sender was the md, anyone could go in and respond. Needless to say I didn't last three days. No way was I going to work for a place like that, keeping narcs unlocked at the nurses station was a red flag too.... But I digress.....

[Mike A. Fungin RN]

HIPPA!!!

[redhead_NURSE98!, ADN, BSN]

HIPAA too!

That doc had better forget it ever happened, unless they want to be dragged into violation land with you. We were either taught, or had a policy (at the time I was a student and didn't care which one it was, just follow it and shut up!) that even talking about the patients on cell phones was unacceptable. I know everyone does it all day but I don't think it's secure.

[PatMac10,RN, RN]

Our hospital had text orders. All hospitalists had a hospital assigned blackberry and each unit had a hospital assigned cellphone (although most nurses used their personal cells to send texts or emails to the hospitalists blackberry). It used to be that you could send text message orders, but now they stopped it for reasons similar to the OPs situation, I think. The hospitalist still have their blackberry's and the units their cell phones. Now you can only receive email orders, telephone order, written orders, and in necessary cases, verbal orders.

Personally I don't see much of a difference in allowing email orders, but not text ones. Same principle. But, IDK. I guess because the email is always sent from your hospital associated email to the hospitalists hospital associated email linked to their blackberry's.

[FlorenceFrightengale]

I havent read all of the posts, my apologies if this has been addressed...

How are you protecting the privacy of patients through cell phone text messages???

Texts are NOT secure. IF you are receiving orders you MUST be identifying the patient in the text. You might want to discover the legalities of what you are doing.

In my case, I'd text Dr. McNotSoDreamyInTheEnd with "potassium came back - 3.2." or "chest x ray is up - please look at."

He'd put the orders in. I wouldn't even say the patient's room number - it was someone we'd already been discussing in person or on the phone.

Still wrong, though.

[nurseprnRN, BSN, RN]

Interesting article.

Healthcare Texting in a HIPAA-Compliant Environment

Healthcare Texting in a HIPAA-Compliant Environment

[nurseprnRN, BSN, RN]

HIPPA!!!

HIPAA!!

[Bortaz, MSN, RN]

HIPPA!!!

Hippo? WHERE!?

[nurseprnRN, BSN, RN]

I can't tell you.

[nurse2033, MSN, RN]

Unless texts are being sent securely, they violate HIPAA. Are you using your personal account for texts? If so, your cell phone can be subpoenaed in a legal case and ALL of your texts entered into the public record. If there is even a written policy on accepting orders via text, I'm sure that it is not allowed. It has no accountability. How do you record that you have received an order via text? How is it entered into the medical record? Do you write the order in the chart? How do you verify read-back? How do you know that it was the MD who gave you the order and not their significant other? Your post shows the obvious problems here. You should cease that activity immediately. Keep all texts related to this incident and see if you can print them out somehow. Good luck.

[dagny1974]

I am sorry to say but you are the one at fault. If you felt it was okay to text with the doctor regarding the results and orders then you are responsible to make sure that you have read all the text messages that the doctor had sent to you. I personally like that I can text my doctors and get a quick answer but when it is serious I always page them and make sure that I talk to them over the phone. When you are in a situation that has a patient that has something major going on then you have to take it upon your self and let that doctor know that they need to call you on the facility phone so you can make sure that you are getting the orders correct.

I work in a sub acute care facility and we don't always have a doctor in house. Most of the doctors and nurse practitioners are texting orders to the nurses. We are also texting questions and lab information to the mds and nps . Today I had a patient with a blood sugar of 600 and paged the doctor and did not get a reply so I texted the doctor And she texted me back stating to get stat labs give additional insulin etc then she proceeded to text orders for three other patients. Med changes and other labs etc. in the middle of her texts she decided to send the patient to the ER after stating to wait for stat labs since the patient was asymptomatic . Well somehow I missed the text send to ER , so when the next shift took over I told the on coming nurse to be on the look out for the stat lab results and call MD as soon as they arrive . Well the labs arrived and when he called the doctor she flipped out saying she gave orders to send mr X to ER And she told the other nurse she is going to sink my ship so to speak for not following orders . I'm sure anyone reading this can see so many wrongs here . Thinking from now on no more texting with doctors . Anyone have any similar situation or thoughts on this issue ?