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 ?

[girtster]

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.

Actually I would say the blame is shared for both the nurse and the doctor as well as the institution allowing this practice.

[Karen Southad]

The hospital I work at has a text message center on the computers we use to chart, we simply go the the "Quick Click" page, click on the MD we want to send message to and typed in a message to them regarding what info we wanted to relate to them, Rm # 7 pt name, leaving our name and hospital phone # assigned to us for that day. Now, however, in the last 2-3 weeks, we have been told our site is not private so all we can do is send a text to the doctor and have them call us back, then relay the message, and they will give us orders. We do all electronic medical records and the MD is supposed to enter the orders themselves but more often than not, the nurses have to input the orders. Also we have 2 hospitalists doctors in house 24/7 to give consistent care to patients. even with this system in place, there are still problems to iron out.