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    The Dangers of Texting Medical Orders

    What might seem like a convenient option has led to serious errors.

     

    The Survey

    Fifty-three percent of the study’s respondents told ISMP that that texted medical orders were not allowed per policy in their facility. The remainder said there was no policy on the topic (19%) or that they were uncertain whether a policy existed.

    The majority of respondents reported a high level of concern about potential risks associated with texting medical orders (Table 1). Medication/patient safety officers, risk/quality managers, and nurses were more concerned about the potential risks associated with texted orders, while physicians were least concerned about them.

    Table 2: examples of errorsMore than half of all respondents felt that these risks, along with failure to retain or document the text message and the inability to authenticate the sender or receiver, were of the highest concern. The risks they were least concerned about included a delay in receipt or transcription of texted orders and the lack of prescriber clinical decision support while texting. Many respondents said that nurses who enter a texted order into the prescribing system, and pharmacists who verify the order should receive any alerts and clarify the orders if concerns arise. However, other respondents noted that the lack of decision support when prescribing could potentially lead to unnecessary variation in practices and transfer responsibility for the correctness of the order from the prescriber to the nurse or pharmacist.

    Seven percent of all respondents said they were aware of errors or close calls that occurred involving a texted order. While this may not be an excessive amount of errors, those described by respondents were primarily associated with types of risks described, some of which are unique to texted orders (Table 2).

    Texting is definitely going to continue, said Cohen. “It is widely used already and unlikely to stop. And there are many things that can be done safely back and forth, such as certain types of non-medication orders and clarifications. We are just saying that at least for medication transactions it’s not ready for prime time.”

    “Leadership must establish and communicate policies on the texting of orders and take a strong stance on avoiding texted medication-specific orders at this time until they can be safely introduced into health care through careful pilot testing and implementation plans,” Cohen said.

    Anthony Vecchione
    Anthony Vecchione is Executive Editor of Drug Topics.

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