They’re convenient, but texted orders put patient safety at risk

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Survey finds pharmacists text medical orders although facilities prohibit the practice

Quicker than a phone call, simpler than an e-mail—text messaging has become the communication mode of choice for many of us. A survey from the Institute for Safe Medication Practices (ISMP) warns health care providers that the use of texting to send medication orders is a bad idea.

ISMP conducted an online survey for patient care providers about text messaging practices and summarized findings in a report, The Texting Debate: Beneficial Means of Communication or Safety and Security Risk?

The survey’s respondents included pharmacists, nurses, physicians and other prescribers, medication and patient safety officers, quality and risk managers, educators, pharmacy technicians, and others; 86% of all survey takers practice in a hospital setting.

More than 30% said they opposed the use of texts for medication orders. Another 40% said texted medication orders were acceptable from encrypted devices only. And while 53% of all respondents indicated that their facilities prohibited texted medical orders, 45% of pharmacists reported that medical orders are texted regularly.

“It’s so easy to pick up your private devices and say, ‘Let me text Dr. Jones or my clinical manager a question,” said Erica Lindsay, PharmD, MBA, JD, principle at Lindsay Law in Chicago and a practicing health-system pharmacist. “When you’re dealing with patient information, that information can remain in the phone, even after deletion. That is putting patients and your hospital at risk.”

ISMP’s report calls for the halting of medication orders by text “until we have the proper software that can ensure privacy and an acceptable error rate, which would be miniscule if any—and that will come, I’m sure,” said Michael Cohen, RPh, MS, FASHP, president of ISMP.

CMS issued a similar directive in 2016, prohibiting the use of texting for patient care orders. The Joint Commission reiterated to its accredited facilities that they should abide by CMS’s rules later that year. In January 2018, CMS clarified that it does not prohibit all text messaging—just patient care orders.

According to the ISMP survey report, 70% of respondents were concerned or highly concerned about unintended autocorrection in texts. In addition, more than half of respondents said they were concerned or highly concerned about use of potentially confusing abbreviated text terminology, potential for patient misidentification, misspellings, and incomplete orders.

For the full article, please visit for the February 2018 issue of Pharmacy Today.

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