Doctor texting order turned into a nightmare

Guest343211 · Feb 15, 2013

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 ?

For the love of....

Um, the doc couldn't see that the situation was a little more involved than the use of text-messaging? This is bad judgment IMO on her part. Of course, early on, I would have said to the doc, do you want me to call you, or do you want to call me, b/c this needs to be given as a verbal order--then she can further verify by fax or email. It's too much for texting. Common sense to me.

Guest343211 · Feb 15, 2013

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.

Just saw your reply dagny.

OP, I have to agree with this. It's already too easy to miss something, have some confusion, and then you and/or the patient can get screwed. Don't risk the pt or your license. If need be, talk to admin about limiting text message orders to very simple, closed questions, and have them make a policy specifying exactly what this means.

Why get screwed over such nonsense. Not worth it.

Guest343211 · Feb 15, 2013

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.

This is also a good point.

occrn21 · Feb 16, 2013

Absolutely not. I can't tell you how many times I receive text messages from friends where the autocorrect has changed words. Bad enough that I have had to decipher doctors notes in charts, let alone text message shorthand.

Wave Watcher · Feb 16, 2013

What happened to the patient who should have gone to the ER? Sorry, if it's been asked, I got hung up on trying to find the hippo.

BrandonLPN, LPN · Feb 16, 2013

Ok, maybe I'm just hopelessly behind the times, but could someone please explain how texting orders is somehow more convenient than, you know, *talking* to someone. When did talking to someone on a telephone become such a difficult thing? Is it really that hard?

"This is a bad, bad idea" should be going off like alarm bells in the mind of nurses and doctors who communicate this way....

Guest343211 · Feb 16, 2013

Ok, maybe I'm just hopelessly behind the times, but could someone please explain how texting orders is somehow more convenient than, you know, *talking* to someone. When did talking to someone on a telephone become such a difficult thing? Is it really that hard?
"This is a bad, bad idea" should be going off like alarm bells in the mind of nurses and doctors who communicate this way....

:) So true. Should be stuff like, "call office or So&So rehab, unit B, Nurse Abe re: a pt. Something like that. Specific details. . .problematic.

tewdles, RN · Feb 16, 2013

We text our medical director and ask him to call us back for orders.

windsurfer8, BSN, RN · Feb 16, 2013

You need written policy on how to receive orders and do not deviate from that no matter what any other doctor or nurse says. If the hospital policy is to take text orders so be it. However I wouldn't even THINK about it unless I have a hospital policy stating it is how to get orders. Anytime you deviate from written policy all bets are off.

gcupid · Feb 17, 2013

Ok, maybe I'm just hopelessly behind the times, but could someone please explain how texting orders is somehow more convenient than, you know, *talking* to someone. When did talking to someone on a telephone become such a difficult thing? Is it really that hard?"This is a bad, bad idea" should be going off like alarm bells in the mind of nurses and doctors who communicate this way....

I've never done it but it would appear to be straight to the point. You have a documented time and there's no issue in regards to what was specifically stated and it can place you in a position to say that I definitely attempted to contact this individual and he/she should have seen the specifics of current matter.... u can ignore a phone call far better than a text; however, in regards to making sure every message is read is where the danger lies. If the md/rn are stuck on texting each other. There should be away that made sure orders are acknowledged so nothing slips through the cracks. Can Doctors just put in their own orders and the machine prompts them when simple clarifications are needed? And can we get an automated system that contacts the correct physician just based off of providing the patient's name/dob/,and/or Medical record number? And could the doctors actually place in their own consults? I could really have this nursing profession a lot less stressful and be more desirable to work in, if anyone with power would consult me...

billyboblewis · Feb 20, 2013

When I have an emergency I call the np direct you have their number if you have been texting them.

girtster · Feb 20, 2013

Ummm, yeah. No more text orders. And don't feel threatened. She can't sink your ship unless you let her. I would also take the issue to mgmt. The entire department should STOP taking text orders.