Nurses, Did You Know? Patient Orders Cannot Be Via Text Messaging

July 17th, 2012


By , BSN, RN

Texting is part of our everyday lives. It is of great use in the workplace, allowing for the exchange of information in seconds whether across the hall or across the country. It allows us to be in the moment with information. In a healthcare setting we can have test results, surgery updates, and other useful info for treating patients in our hands almost instantly.

Texting is distracting. A friend who lives in a city where many people walk everywhere had me in stitches one day describing her disdain for others who text and walk. She describes literally running into people who have stopped walking without warning to respond to a text message. I have actually had this happen in the hospital hallway.

Texting is also dangerous, on a lot of levels. You can throw a comment out there into the universe and it is there forever. Be careful what you text about your manager, the night nurse, or your employer—you don’t really know who sees what you type.

Finally, texting can be deadly. We are bombarded lately with advertisements and public service announcement of the dangers of texting while driving. My fellow blogger, The Nerdy Nurse, recently produced a column titled, “DWI: Driving While Intexticated.”

“There are certainly some downfalls to being constantly connected. Distracted driving is one of the deadliest. There is a generation who thinks that texting while driving should be ok and that they are perfectly capable of doing so without error," writes The Nerdy Nurse. “Research says that upwards of 20% of car accidents are related to cell phone use. Roughly a million automobile accidents a year could be avoided if we eliminated the cellphone while driving. Studies also suggest that texting while driving can make a car crash 23 times more likely than those who are completely focused on driving.”

Texting and Healthcare

So what about nursing and doctoring while texting? How safe is that for healthcare and our patients?

Back in December of last year, the New York Times published an article titled, “As Doctors Use More Devices, Potential for Distraction Grows.” The gist of it was that despite the access that computers and smart phones allow us to have to information, in many cases that same access is taking our eyes off our patients.

"This phenomenon has set off an intensifying discussion at hospitals and medical school about a problem perhaps best described as 'distracted doctoring.' In response, some hospitals have begun limiting the use of devices in critical settings, while schools have started reminding medical students to focus on patients instead of gadgets, even as the students are being given more devices.”

I have worked at a number of teaching hospitals and while answering pagers used to be the bane of my existence, now it is returning text messages. My interns, residents, and fellows, who are in the operating room learning the surgical procedures they will base careers on are constantly inundated with text messages.

These physicians, still in the student role in most respects, are pressured to always be in touch. They jump when the bell rings and they immediately want me to read them the message, and answer for them. There are, to my mind, a lot of problems inherent in this phenomenon. What we are talking about here are the words I used at the beginning of this blog: distracting, dangerous, and deadly.


First the distraction. In my arena, the operating room, if you are talking to me about your text message, and thinking about another patient, you aren’t paying attention to the patient at hand—and as the nurse, neither am I. This is how instruments and sponges get mislaid, how orders get disordered, and how the people around you end up with needle sticks and other injuries.

Now, don’t get me wrong. I know as well as every other nurse and doctor that healthcare is about multi-tasking. And, I understand the pressures of being expected to respond immediately—that’s why we are given these devices. However, you would be hard pressed to convince me that all these distractions aren’t dangerous.

A 2010 survey on cell phone use while performing cardiopulmonary bypass (CPB) was published in the professional journal, Perfusion. In the article almost half (49.2%) of the 439 perfusionists surveyed admitted sending text messages while performing CPB, 21% admitted to accessing e-mail, 15% used the internet and 3.1% were socially networking.

Safety concerns were expressed by 78.3% who believe that cell phones can introduce a potentially significant safety risk to patients.


Now, on to dangerous. Today’s fixation on the computer screen isn’t new, just different. In nursing school I had an instructor who was always repeating, “look at the patient, not at the monitor.” Meaning, the monitor may show no heartbeat, but if the patient is sitting up and talking, check the leads.

The same wisdom applies to our computer access. In surgery, if anesthesia providers (CRNAs and MDs) are sending text messages, they aren’t actually looking at the monitors, which in this case is the most important task.

On the floors, nurses are always needing new or updated orders: for medications, for blood, for procedures—any number of things. They text the doctor for those orders, including in the text the patient’s name, medical record number, symptoms, diagnosis—again any number of things. How do the nurses know the doctors are the only one’s reading the text message? The answer is they don’t and we are looking at HIPAA or health information privacy violations.

In fact, The Joint Commission made it very clear in 2010 that texting and physician orders do not go hand-in-hand. “… it is not acceptable for physicians or licensed independent practitioners to text orders for patients to the hospital or other 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.”

For an RN looking for patient orders, 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.


Finally I come to the deadly. This example will bring us full circle and is a harsh reminder that even though we are trained in healthcare to multi-task texting is sometimes just too dangerous and none of us is immune—not even a physician.

In 2010, Dr. Frank Ryan, a Hollywood plastic surgeon, plunged to his death over an embankment while driving along the Pacific Coast Highway. Just before the deadly accident, Ryan was updating his Twitter page via his mobile phone. Ryan was not just a plastic surgeon to the stars; he had also given of his skills, donating much of his time to helping former gang members by removing their tattoos.

This was a needless death of a healthcare professional. And no, he was not texting about a patient or a procedure but about personal matters when he died. The point is we grow so used to the immediacy of texting and the ability to multi-task that we forget and do it all the time.

Next time, it might not be the doctor, but the patient who suffers the ultimate loss. The point is texting is distracting and can be worse. Texting is a tool that should be used judiciously in the healthcare setting.

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