Survey highlights prevalence, risks of text messaging medical orders

A recent survey suggests medical orders are commonly transmitted via text message even though the majority of respondents said their facilities have policies prohibiting the practice.

The is a divisive issue, according to the Institute for Safe Medication Practices (ISMP), which published the survey in November.

“Technology-savvy healthcare professionals have embraced the convenience of this 21st century form of communication, while opponents feel it is too informal to properly document patient care,” the survey authors wrote. “They also have concerns about data security and the potential impact on patient safety with texting medical orders.”

A total of 778 respondents filled out the ISMP’s online survey over a three-month period. Respondents included nurses (40 percent), pharmacists (38 percent), physicians and other prescribers (7 percent), medication/patient safety officers and quality/risk managers (7 percent) and others (8 percent) such as educators or primary technicians.

Here are some of the results:

• 33 percent of all respondents are against medical orders being texted under any circumstance and another 40 percent believe it is only acceptable when using an encrypted device application. Twenty-six percent of physicians believe this practice should be allowed in any circumstance, compared to 15 percent of nurses and pharmacists and only 4 percent of medication/patient safety officers and risk/quality managers.
• 53 percent of those surveyed said their facility had a policy against texting medical orders and another 16 percent were uncertain whether a policy existed. Twelve percent said texting was allowed, including 8 percent if using an encrypted device and 3 percent under any circumstance.
• 45 percent of pharmacists and 35 percent of nurses reported texting was used in their facilities. More than half of the respondents who said they received texted orders did so at least once a week.
• 42 percent indicated standard cell phones were the only devices on which they received texted orders. One-quarter said they received orders on both encrypted devices and standard cell phones, indicating standard phones were still being used even when encrypted devices are available.

The respondents also weighed in on the risks of texting medical orders. Seventy percent were “concerned” or “highly concerned” about autocorrection possibly leading to incorrect drug or patient names, and many commented autocorrect features should be disabled on devices used for detecting orders.

A majority of healthcare professionals were also concerned about potentially confusing abbreviated text terminology, misspellings, incomplete orders and the potential for patient misidentification.

“Medications could be dispensed and administered to the wrong patient if a spelling error occurs, or autocorrection changes the intended patient’s name,” wrote the survey authors. “In addition, there were repeated comments from respondents who alarmingly said they only include the patient’s initials, unit, room number, or another abbreviated patent identifier with their text messages and orders to offset the risks associated with the security of protected patient information. … Most texted orders must be entered as free-text rather than selecting drugs and doses from a drop-down menu, or via a voice-recognition feature that may mishear and, thus, misspell words, including drug names.”

While acknowledging text messaging of medical orders is unlikely to subside based on convenience, the survey authors said text reporting poses unique risks that haven’t been overcome. For this reason, they suggested suspending this practice for now.

“The texting of medication-specific orders should not be allowed until the safety issues have been identified and resolved through advanced technology along with the development of vetted, industry-wide clinical guidelines that can be employed in organizations to ensure standardized, safe, and secure texting processes,” they wrote. “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 healthcare through careful pilot testing and implementation plans.”