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Do you text your patients?

As the title states. It is difficult to understand rules, regulations, and the impact of modern technology. I am wondering how many NP's text their patients, and what they think is appropriate, vs when to use the phone.

Jules A, MSN

Specializes in Family Nurse Practitioner.

I have only given 3 parents or grandparents my cell number over the years due to complicated cases and the need to communicate often. I used to text with one grandmother but figured since she was willing to text and it was two way communication that consent was implied. Thankfully they never abused it.

I have never given my number to an adult patient and have no plans to in the future. My thought is the parents of sick kids might need and deserve a bit more hand holding than I'm willing to give adults who I expect to have more self reliance and the ability to contact my secretary if they have a question or message for me.

RiskManager

Specializes in Healthcare risk management and liability.

From a risk management and compliance perspective, I am generally not a fan of making or receiving patient texts containing clinical information. Texting them about appointment reminders or the like is fine. Texting does not appear in the chart, raising concerns about continuity of care and documentation, and unless you are using a secure texting service, HIPAA issues for texts containing PHI are a concern. TJC has taken a dim view of texting going back to late 2011 and continuing to the present: To Text or Not to Text? | Joint Commission

I swore I would never give my number out again after a patient drove me crazy for 2 years.

That said I gave it out 3weeks ago to a patient. It was an important situation and this patient has been very respectful.

So I am pretty wishy washy.

From a risk management and compliance perspective, I am generally not a fan of making or receiving patient texts containing clinical information. Texting them about appointment reminders or the like is fine. Texting does not appear in the chart, raising concerns about continuity of care and documentation, and unless you are using a secure texting service, HIPAA issues for texts containing PHI are a concern. TJC has taken a dim view of texting going back to late 2011 and continuing to the present: To Text or Not to Text? | Joint Commission

Joint commisions list of problems with texting from 2011 when they were first against it are all problems that are easily overcome. Now they have a blog post worrying about abbreviations in texting?

I can can name a few more pressing matters if they are interested.

Jules A, MSN

Specializes in Family Nurse Practitioner.

Joint commisions list of problems with texting from 2011 when they were first against it are all problems that are easily overcome. Now they have a blog post worrying about abbreviations in texting?

I can can name a few more pressing matters if they are interested.

Lol yeah.

Something Riskmanager mentioned that I do feel is worth noting is that any time I communicate with a patient whether on the phone or in the rare case via text I add a brief note in the chart for continuity of care.

PG2018

Specializes in Outpatient Psychiatry.

I do not use my personal phone to communicate with patients. I'm even skeptical of giving out my work email to school nurses. My stance is if things get bad they can call 911, go to the ER, or if able walk-in to my shop. The therapists are notorious about contacting patients via personal cell. I cannot imagine getting texts from patients because they can't sleep or something. Ugh. I don't want to set limits or boundaries other than communicate with me through the office staff or the after hours call number that some therapist answers. They rotate or something...idk.

traumaRUs, MSN, APRN, CNS

Has 27 years experience. Specializes in Nephrology, Cardiology, ER, ICU.

Our practice uses Perfect Serve which has encrypted texting and is HIPAA compliant. We also have secure phone messaging...ie we use our personal cell phones to call pts but when it rings at their end, it shows the name of our practice and when they answer they here: "a provider from XYZ is trying to reach you, will you accept the call?"

Our pts love it!

Perfect Serve also allows us to send pictures to other providers and again its encrypted.

We love it.

BostonFNP, APRN

Has 9 years experience. Specializes in Adult Internal Medicine.

I do give my cell phone number out at times and I do occasionally text message with patients under extenuating circumstances. I do transcribe any/all conversations into the medical record via a telephone encounter. I never text identifying information.

I have only once had a patient that abused it, I was direct with the patient about the action that would follow if the abuse continued, and it stopped.

I do find it helpful and time-saving for me and providing good care for the patient, most of the time

Thanks for all of the responses. I use my cell phone every day to contact patients, and have never had one abuse it. My cell phone is on my card, so they already have it. I do tell them "If you have a question, and it is a reasonable time during the week, I will probably answer. But don't take that as a guarantee. At night, we share call, so use our main number if your question can't wait." Patients are always respectful.

I do text some of my most common patients, but not medical information. Only vague discussions. If it gets too detailed, I ask them to wait until I can call them. I will text things like "OK, called in your refill". Or "Got your message, I will call you when I get a chance."

I would be afraid of the first scenario and also possible HIPAA issues.

Jules A, MSN

Specializes in Family Nurse Practitioner.

I do text some of my most common patients, but not medical information. Only vague discussions. If it gets too detailed, I ask them to wait until I can call them. I will text things like "OK, called in your refill". Or "Got your message, I will call you when I get a chance."

No secretary to shield you from general questions or handle refill requests?

IsabelK

Has 12 years experience. Specializes in Internal Medicine, Geriatric Medicine.

Simple answer: NO! If they need to reach me, there are phone numbers to use.

rnsrgr8t

Specializes in Peds Urology,primary care, hem/onc.

I do not give my personal cell phone to my patients. If for some reason I would have to call them from my cell, I would block my caller ID so they did not get the number. I do not give out my work email to them either. We have a patient portal that our patients can email us through (and it automatically populates in their chart) which I LOVE (and the patients do as well). Every encounter I have with a patient (phone/email etc) always gets transcribed into the chart documenting the discussion. That being said, my patients really would have no reason to contact me on my cell as we have an on call team and direct # for them to call after hours etc.

The texting thing makes me nervous about HIPPA etc. I would be more open to it if we had the service @trauma was talking about.

synaptic

Has 5 years experience.

i probably wouldn't. a few nurses at the hospital have mine and don't really abuse it but they continue medical questions always come strolling in and again if we give out any information and something happens (rare but it can), in this sue happy nation we live in it can always be used against us.

I know it sounds as I provided a self centered response but top quality medical care usually doesn't occur during texting.

Jules A, MSN

Specializes in Family Nurse Practitioner.

i probably wouldn't. a few nurses at the hospital have mine and don't really abuse it but they continue medical questions always come strolling in and again if we give out any information and something happens (rare but it can), in this sue happy nation we live in it can always be used against us.

I know it sounds as I provided a self centered response but top quality medical care usually doesn't occur during texting.

I get texts from my RNs all the time. We limit the identifiers of course but I find it extremely helpful for the non urgent notifications. I dislike talking on the phone and hate voicemails.

synaptic

Has 5 years experience.

oh i meant for like issues of their own. not on patients. makes it easier caring for patients though. plus the less i hear my beeper going off the more i enjoy my night. if you don't believe in pavlovs (spelling) dog then you will once you hear a beeper go off 50 times per night lol

Jules A, MSN

Specializes in Family Nurse Practitioner.

oh i meant for like issues of their own. not on patients. makes it easier caring for patients though. plus the less i hear my beeper going off the more i enjoy my night. if you don't believe in pavlovs (spelling) dog then you will once you hear a beeper go off 50 times per night lol

I don't carry a beeper, its all via cell for on call calls but the neurologic zap I get from hearing that damn phone ring is horrible, lol. By the end of my 4 days on call I'm blotto. People who haven't ever been on call can't begin to imagine how disruptive it.

I tend to be in a hypo manic state the whole time because I have to remain mentally sharp in the face of minimal sleep and constant interruptions. Being able to quickly come up with an intelligent, safe solution for a problem at 3am can be challenging, at least for me anyway. :)

Never. I have also stopped giving out my direct extension at work and am now directing patients to the receptionist or nursing line.

99% of my calls and messages could/should be handled by someone else. I found that by my being involved they generally took much longer to resolve and wasted a great deal of time.

You REALLY, SINCERELY, URGENTLY need to speak to me and only me? You know where I work every day ... If it's not worth making an appointment to you, why on earth should I give you my time off the clock?

synaptic

Has 5 years experience.

yeah its rough. taking call is so distracting. but I'm in house during that time which helps some. taking care from home would be irritating to say the lease but unfortunately needed in our fields.

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