Phone, cell, beeper and texting.

[imintrouble]

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 hospital. Apparently it happens more often than I thought.

The last 4 new MDs to the area only provide cell numbers. No home phone or beeper. We have to leave voice messages when the cell is not answered.

The old MDs still answer their home phones after office hours, day and night. We also page them, and for the most part you can expect a return call within 15 minutes. They don't know if I'm calling for an MI, or for Zofran for nausea. There is no hierarchy of needs. There's no screen. I call, they answer.

I don't want to appear resistant to change. However, it feels wrong to leave personal pt info on voice mail. Then the new MDs basically screen the calls, because sometimes they call back and sometimes they don't. Is this the way bigger facilities' nurses contact MDs? How many times do you call the cell and leave a message?

Larger hospitals in the area have hospitalists around the clock, and the middle of the night phone calls to PCPs are a thing of the past. We'll probably get the hospitalist program too, but as in all things, a little later than everybody else.

What do the rest of you do when you need orders from an MD?

Do you think it's inappropriate to leave personal pt info on a cell phone voice mail?

Is it harmless, a sign of the times, and I just need to get with the program?

[RNinCLE, ADN, BSN]

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.

[traumaRUs, MSN, APRN]

In a word, HIPAA.

I'm an APN and I use only my cell phone. My voicemail on my cell phone states who they have reached, which practice I work for and to leave a brief message.

[imintrouble, BSN, RN]

In a word, HIPAA.

I'm an APN and I use only my cell phone. My voicemail on my cell phone states who they have reached, which practice I work for and to leave a brief message.

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?

[RunninOnCoffee]

I leave a msg with only my name, unit, hospital and call back # on it. No pt details, however I just realized when the answering services page I guess they send them the pt name and details though. Me, personally , have never left pt details in the MSG.

[ukjenn231]

I worked at a hospital with text paging. I loved it and the doctors liked it because it helped them prioritize. Sometimes they would not have to call back - you could text, "pt XX in room 4 has a K of 3.0, please advise." Then a few minutes later an order for potassium would pop up. If they didn't respond, we'd use the paging system and try to contact them. However, I have heard that at that hospital the use of text paging was being limited anymore because people were texting "books" about critical situations which was inappropriate. I didn't text regarding critical situations.

If I have to leave a message on a doctors voicemail I only state "This is Jennifer a nurse at XX hospital. I am calling regarding your patient in room 222. Please call back at this number."

If I can't text, I prefer paging services because the service documents each time you put out the call, so therefore it is on record when you attempted a call a doctor 5 times and he or she did not call back. I've also had a doctor tell me she preferred the paging system for the same reason. (Ironically, it was a doctor notorious for not returning calls..) But I know some doctors have their pages texted to them, so the patient's info is relayed on the text message.

I think it all comes with the times, if doctors and nurses can work together using new technology in the best interest of the patient, I feel that everyone benefits.

[joanna73, BSN, RN]

We don't text Doctors, but we are calling cell phones for orders, and leaving a brief message re: patient concerns is common. That's the norm.

[madwife2002, BSN, RN]

As said on a previous thread, I text my MD with simple requests or asking for orders

Sometimes I email him for longer decisions I need

If it is an emergency then I call him on his cell phone or who ever is on call-answering services take too long and I am giving them as much critical information as if I was texting or calling him direct!

They ask nonsensical questions and delay responses from the dr, they have no medical knowledge and it seems to take for ever when all you want is a instant order, which 9 times out of 10 you already know what to do you just need the go ahead.

Text messaging gives you a time line plus it confirms that you contacted the dr and if he responded or not

You obviously have to use common sense when using such forms of communication

[dirtyhippiegirl, BSN, RN]

We text to the dr's pager for non-critical things like a k+ of 3, a positive response to an intervention, etc. As a night nurse, I like the option because I'm less likely to be screamed/snarked/lectured at for waking someone up. /kind of sad, actually

[Esme12, ASN, BSN, RN]

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/standards_information/jcfaqdetails.aspx?StandardsFaqId=401&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

[RNperdiem, RN]

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.

[amygarside]

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.

[BrandonLPN, LPN]

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?