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 ?

[RNewbie]

Is it even legal? I thought orders were written, telephone, or verbal. I worked at a facility where we could alpha page the docs with a message about what the issue is. They would call back to give orders. Texting orders sounds like it could work but not through someone's personal phone. Too many things can go wrong. Maybe if there were special phones used or if someone was responsible for checking the phones for any new orders.

If the docs have time to text back couldn't they just call?

[eatmysoxRN, ASN, RN]

It is our policy that we can not accept text message orders (not that I'd want to). That practice needs to stop now.

~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~

[edmia, BSN, RN]

You paged the doctor and she did not answer the page. If she's making trouble it is only because she messed up. You texted her because she did not respond via the approved communication method and you had a patient who needed orders immediately.

A lot if systems are wrong here, including no protocols in place to handle such a situation . Don't let the doctor throw you under the bus when you were left without the resources to manage your patient.

Tell them that from now on, if a patient has a crisis and the MDs don't respond to pages and you have no protocols or standing orders to deal with the issue, you will call 911 and send patient to the ED.

Sent from my iPhone using allnurses.com

[madwife2002, BSN, RN]

I have texted my MD because he always answers his texts and we get a very quick response to what we need. Sometimes I just text call me!

It honestly depends on the situation and how it is managed!

Also I have proof that I did contact the MD, at what time and what he said or did

I love using my cell phone to call the Doctors rather than the unit phone as I am able to look back and establish a very accurate time line!

It helps with my documentation

[madwife2002, BSN, RN]

Text messages are discoverable in a court of law and are being used frequently as supportable evidence.

If you use this form of communication, then you need to take responsibility for it, remember it is very hard to dispute the written word.

[xoemmylouox, ASN, RN]

I'm surprised to hear that it is allowed to text orders... This sounds like a huge risk and this is a prime example of what can go wrong.. No thanks.

[traumaRUs, MSN, APRN]

In my practice, it has been declared a HIPAA violation as texting is not secure.

[iluvivt, BSN, RN]

The Joint Commission stated in 2010 that texting for the MD/LP orders is not an acceptable practice in all healthcare setting.

This method provides no ability to verify the identity of the person sending the text and there is no way to keep the original message as validation of what is entered into the medical record,

Read-back is impossible in a text message, you have no ability to verify the identity of the person sending the text and there is no way to keep the original message as validation of what is entered in the medical record.

[blondy2061h, MSN, RN]

Unencrypted text messages, like those on cell phones, are a HIPAA violation. I also agree with the person that said he's likely worried his butt is on the line for not answering a page. Why was the patient being sent to the ER for being asymptomatic?

[klone, MSN, RN]

In my practice, it has been declared a HIPAA violation as texting is not secure.

Yep, us too. No phone texting, no text pages, discussing patients, ever! Something like a $10,000 fine, PER INCIDENT, if it's ever discovered. Such a HUGE HIPAA violation.

[FlorenceFrightengale]

It's not good practice. I can say this because I've done it. I was dating a doctor and would text him back and forth about orders. Never once did a patient's name get used, but I realize that this was still a terrible thing. What if somehow my cell had been confiscated? (Especially since there were certain other texts that we wouldn't want management to find out about!)

*slaps self on wrist*