Horsham, PA—Nearly half of pharmacists in a recent survey report that they regularly receive medical orders via text messaging.

The survey by the Institute of Safe Medication Practices (ISMP) said that 45% of pharmacists and 35% of nurses in their poll reported that medical orders are regularly being texted. Of those receiving texted orders over the past year, more than half said the practice was extremely common; 20% received this type of message daily, and 35%, at least every other week. Another 17% reported being texted medication orders once or twice a month, with the remainder received them less frequently. 

While the practice has become more common, most of the participants in the recent ISMP survey expressed strong misgivings about it. Among the concerns were the potential for lack of order clarity, completeness, and correctness. In addition, the survey respondents pointed out difficulties in the ability to retain or document the text message, as well as to authenticate the sender and receiver. 

The 778 respondents included nurses (40%), pharmacists (38%), physicians and other prescribers (7%), medication safety officers and quality/risk managers (7%), and others, such as educators and pharmacy technicians (8%). Most (86%) practiced in a hospital setting. 

Overall, 33% of all respondents said they do not believe medical orders should be texted under any circumstance in healthcare. The practice was considered acceptable by another 40% only if an encrypted phone/device application was used. 

Only 12% of those responding to the survey said that texting was allowed in their facility by organizational policy.

For those who supported use of texts for medication orders, nearly half wanted restrictions on orders for chemotherapy and medications that require complex order sets; a fourth of them thought text orders for controlled substances and other high-alert medications should be prohibited.

Here were some of the other concerns:
• 70% of respondents expressed alarm about unintended autocorrection of medical terms, approved abbreviations, drug names, or patient names that are unlikely to be in the user’s phone/device dictionary. 
• 66% said they worried about use of confusing abbreviations such as 2day for today, 2 for to, b/4 for before, 3D for 3 times daily, and MT for empty. At the same time, nearly half, 46%, of physician respondents said that texted orders contain those potentially confusing abbreviations, and 30% said they are used frequently. 
• 60% noted concerns about patient misidentification, especially if abbreviated patient identifiers are used to avoid security risks.
• 58% stated worries about misspellings of patient names, drug names, or dosages, because the texts don’t offer drop-down menus. Especially concerning: using voice recognition tools.
• 56% warned of incomplete orders because texts don’t have the types of prompts found in electronic prescribing systems, which could lead to missing instructions.

ISMP urged that texting medication-specific orders be discouraged until safety issues have been identified and resolved through advanced technology. The group also endorsed creation of industry-wide clinical guidelines to help ensure standardized, safe, and secure texting processes. 
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