Phone, cell, beeper and texting. - page 3

by imintrouble, BSN, RN | 6,329 Views | 39 Comments

Nurses are texting MDs. Cell phones instead of home phones. Beepers are obsolete. What's the world coming to? Change comes slowly to my area of the country. Texting for orders instead of talking, is slowly making its way to my... Read More


  1. 5
    Quote from imintrouble
    Do you use that brief message to judge which situation you can postpone? Or do you respond to each with the same speed?
    Obviously somebody with a pressure of 70/30 would need a quicker response than somebody who had an earache.
    Do you use your cell phone to screen?
    Your facility should have a policy and decision tree about a MD not responding to pages/calls/texts that states what to do and who to call when you need someone and have not gotten a response and a time limit on calling back before you continue up the MD food chain to call the head/chief of that service. A facility I worked at had set parameters for call backs with a protocol for placing 911 as apart of the message that changes the protocol to emergent and the MD has less time to return the call before the decision tree is enacted.

    Unfortunately.....the technology has preceded the rules...again.

    The Joint Commission has issued a position statement about this and they do NOT approve the use of cellphones/texting as a means of communicating patient data. I know that I will get some unhappy responses....however......
    Texting Orders
    New | November 10, 2011

    Is it acceptable for physicians and licensed independent practitioners (and other practitioners allowed to write orders) to text orders for patients to the hospital or other healthcare setting?

    No 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. http://www.jointcommission.org/stand...01&ProgramId=1

    Monday, November 21, 2011
    Joint Commission: Text Messages Should Not Be Used in Patient Orders On Friday, the Joint Commission issued a statement saying that physicians and other health care professionals should not use text messages as a way to share patient health information, Fierce Mobile Healthcarereports.
    The statement came in response to a frequently asked question on the organization's website.
    The statement said, "It is not acceptable for physicians or licensed independent practitioners to text orders for patients to the hospital or other health care setting," adding, "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."
    Read more: Joint Commission: Text Messages Should Not Be Used in Patient Orders - iHealthBeat
    If a facility chooses to develop a policy that allows texting....you may follow the policy....but it may not protect you in a lawsuit about HIPAA or delay in treatment and malpractice for the policy is not following standard of care/malpractice and provide for the ability to verify the orders to the MD by read back if an error is made.

    While it may have become common practice at some facilities.....the reliability and legality has yet to be tested in a court of law......and it definitely has NOT been approved by the Joint Commission.

    I have no problem with calling their cell phone but my expectations for the return phone call remain the same. I have not worked at a facility that allows texting of ANY orders.

    If you talk about HIPAA and texting that is a whole different discussion. It is generally considered non compliant with regulations
    Unless the text messages are protected by the hospital's security system, both practices would be in violation of the HIPAA rules and can have additional consequences in other areas. Clearly, both practices include protected health information under HIPAA, since patients' names are used, rather than a chart number or other non-personal identifying method. Although the use of the PHI without an authorization is permitted under the Privacy Rule of HIPAA for treatment, payment or operations, the use must also meet the Security Standards of HIPAA.

    The Security Standards require Covered Entities to (1) ensure the confidentially, integrity and availability of the information; (2) protect against any reasonably anticipated threats or risks to the security or integrity of the information; and (3) protect against unauthorized uses or disclosures of the information. The Technical Standards specifically require a covered entity to address transmission security, implementing technical security measures to guard against unauthorized access to PHI that is being transmitted over an electronic communications network. The security standards add that specifications to implement transmission security include both integrity controls and encryption.
    Text Message Use Among Providers Raise HIPAA Concerns


    Last edit by Esme12 on Feb 19, '13
    Dazglue, tewdles, imintrouble, and 2 others like this.
  2. 2
    Your post brought back memories of dealing with answering services.
    The inability to contact doctors when you really need one is a big reason I took a job in a big university facility where there is always a resident or hospitalist available.
    While I have never texted anyone outside of work, I love that function for work. The pagers are not the doc's personal pagers, they are for work.
    You are not sending a text message about patient information to John Doe's personal pager, you are sending it to the Orthopedic resident on-call pager.
    anotherone and imintrouble like this.
  3. 1
    Texting can be a form of communication between nurses and MDs, it is an accepted way of giving and receiving orders. Although it can have its limitations but people still use them.
    imintrouble likes this.
  4. 3
    I don't care what anyone says, nurses and doctors communicating via text messages is just bad practice and should be fought against. Seriously, *what* is so hard about talking to someone on a telephone?
    GrnTea, imintrouble, and joanna73 like this.
  5. 3
    It seems I might have to learn some new tricks as far as communicating with MDs.
    I've been giving it some thought, because I really oppose the new way. Texting, and leaving messages on cell phones.
    When I say texting, I mean nurses are using their personal cell phones. Not hospital equipment.
    Right now personal cell phones are the only way a nurse can text an MD. We are really low tech here in rural USA.
    Clarification: I have never used my personal cell to text MDs.

    It seems around here, there's a fundamental shift in how new MDs view their pts.
    More than ever pts are just a business. We don't have access to new MDs home phones, they don't want to be bothered. There is almost nothing that can't wait til morning. Leaving a message on a cell, allows the MD to hear it, then decide if they need to wake up enough to address the issue.
    We have no policy regarding the MD not returning a call. He can listen to the message, decide it does not need to be addressed, but not share that thought with me by returning my call. It's disrespectful, to me and the pt.
    And then there's the whole HIPAA thing. Leaving personal infromation on a cell phone voice mail just goes against decades of ingrained nursing beliefs.
    Last edit by imintrouble on Feb 19, '13
    tewdles, BrandonLPN, and GrnTea like this.
  6. 4
    Quote from RNinCLE
    Our texting is also done through an online system. If they deny getting a page, they can all easily be traced - and yes, we've had to do it.

    It is also our policy that docs are required to respond to a page within 5 minutes.
    Same here. You all talk as though your facilities have NO policies about this stuff! Really? We almost ONLY text MDs/NPs any more, through our online system. They usually respond by entering orders into the online chart. Rarely do they actually call back and we have an actual person-to-person phone exchange. They must respond to any text/page/request from us within 15 mins. This policy is ENFORCED, any response over 15 mins gets logged & dealt with by their Medical Director.

    And THANK GOD! This means two positive things: 1) ALL information being exchanged is IN WRITING and recorded in the online system (no "he said/she said" arguments about a phone conversation later) and 2) it encourages nurses to make requests and write texts that are CRYSTAL CLEAR and well-articulated, because if they aren't, guess what? The DREADED phone call. The MD will call you & you'll actually have to TALK to them to clarify, and it's SUCH a huge interruption in your busy day!!!! Trying to understand their thick accents and jibber jabber is such a pain! Then you gotta document the stupid phone call and every word said. God, just read the text, review the chart & my notes in the system, enter orders for me to carry out, and leave me ALONE! We also have 24-hour coverage of MDs that are always reachable by text page who also have access to all charts via the Web.

    I trust computers and robots and machines FAR MORE than I've ever trusted, or will EVER trust actual human beings. I think health care's increasing reliance on this kind of technology is more a sign of how UNRELIABLE and IDIOTIC "people" have become than some sign of impending doom about the apocalypse. I thank my lucky stars I work for an employer that has a way to trace and document and record everything in writing, is computer savvy, and DISCOURAGES verbal info exchange!

    Also I don't know a single soul who has a land line home phone any more. Not even my 70 year old mother in rural Minnesota.

    Viva technology! All of this is about 30 years behind. I'm excited to see health care finally starting to catch up to the future. Embrace it, or you'll get left behind.
    wooh, Melodies of Legend, anotherone, and 1 other like this.
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    In my previous posts, I talked about text-paging docs. But that's also from within a huge medical system where I am text paging from a computer, using an internal tool designed for this specific purpose. And there is no way for the doctor to respond to me other than to call me on the phone, or put an order in the computer.

    In the situation you describe, I completely agree with you. There is no way I would use my personal cellphone to text an MD. That is bad practice. And no one should be texting orders to a nurse's personal cellphone. There are just so many ways that could end badly.

    Personally, I don't think you need to learn "new tricks". I'm not sure what type of facility you're working in, but I think I would work/discuss with management re: putting some protocols in place on what is appropriate and what is not. I would have serious issues with working in the way you've described.
    anotherone, RNperdiem, and imintrouble like this.
  8. 2
    I would be very uncomfortable using my own cell phone to text a physician. Our hospital has one of those systems in which we can send a text to their beeper, which can be tracked. They recently changed what we are allowed to text due to HIPAA. Basically, we're limited to something like "Pt concern, please call." I liked it better when we could give them a little more information. However, I do recall my preceptor at a different hospital advising me to keep texts vague so that the physician would call back.
    anotherone and imintrouble like this.
  9. 1
    I love AN, but there is such a disparity in our working conditions it's hard for me to imagine some of the things I read here as far as technology goes. I know it's hard for some of you to imagine just how bare technology is in some parts of the country.
    The new MDs we have are no doubt used to giving and receiving info the hi-tech way. Computers. We can't do that, but the new MDs still want to limit our ability to contact them.

    There are some nights I wish I could call old Dr Smith who routinely yelled and ranted, but listened and gave me orders that I could hear.
    Instead of new Dr Smith who doesn't want to be bothered after 0000, and will not answer his cell, and won't return the call unless I leave a message first.
    anotherone likes this.
  10. 0
    Quote from mclennan
    Same here. You all talk as though your facilities have NO policies about this stuff! Really? We almost ONLY text MDs/NPs any more, through our online system. They usually respond by entering orders into the online chart. Rarely do they actually call back and we have an actual person-to-person phone exchange. They must respond to any text/page/request from us within 15 mins. This policy is ENFORCED, any response over 15 mins gets logged & dealt with by their Medical Director.

    And THANK GOD! This means two positive things: 1) ALL information being exchanged is IN WRITING and recorded in the online system (no "he said/she said" arguments about a phone conversation later) and 2) it encourages nurses to make requests and write texts that are CRYSTAL CLEAR and well-articulated, because if they aren't, guess what? The DREADED phone call. The MD will call you & you'll actually have to TALK to them to clarify, and it's SUCH a huge interruption in your busy day!!!! Trying to understand their thick accents and jibber jabber is such a pain! Then you gotta document the stupid phone call and every word said. God, just read the text, review the chart & my notes in the system, enter orders for me to carry out, and leave me ALONE! We also have 24-hour coverage of MDs that are always reachable by text page who also have access to all charts via the Web.

    I trust computers and robots and machines FAR MORE than I've ever trusted, or will EVER trust actual human beings. I think health care's increasing reliance on this kind of technology is more a sign of how UNRELIABLE and IDIOTIC "people" have become than some sign of impending doom about the apocalypse. I thank my lucky stars I work for an employer that has a way to trace and document and record everything in writing, is computer savvy, and DISCOURAGES verbal info exchange!

    Also I don't know a single soul who has a land line home phone any more. Not even my 70 year old mother in rural Minnesota.

    Viva technology! All of this is about 30 years behind. I'm excited to see health care finally starting to catch up to the future. Embrace it, or you'll get left behind.
    You have no idea Wouldn't it be cool if you could drop into my hospital and I could drop into yours for a day? We'd both be equally shocked. Me pleasantly, you ...not so much.


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