What’s New in the Patient Safety World
January 2017
Joint Commission Thinks Twice About Texting Orders
Thank goodness The Joint Commission listens. In our May 24,
2016 Patient Safety Tip of the Week “Texting
Orders – Is It Really Safe?” we decried The Joint Commission’s proposed
rescinding of its ban on texted orders.
The Joint Commission had announced its intent to rescind the
ban on texting orders in April 2016 (TJC
2016a, TJC
2016b). But shortly thereafter TJC put a temporary hold on that rescinding,
therein keeping the ban on texting orders while it gathered more input and
information (TJC
2016c).
In our May 24, 2016 Patient Safety Tip of the Week “Texting
Orders – Is It Really Safe?” we identified the following areas of concern
regarding texted orders:
- Bypassing clinical decision support tools
- Taking the easy way and avoiding CPOE as a shortut
- Ordering in a vacuum (without important clinical information in the
chart that might impact orders)
- Promoting telephone tag
- Failure to allow the recipient to ask appropriate questions
- AutoText/AutoCorrect issues
- Security issues
- HIPAA issues
See that previous
column for details on each of those concerns.
Now The Joint Commission, in conjunction with CMS (Centers
for Medicare & Medicaid Services), has clarified position on texting
orders, reaffirming that sending orders
via a secure text messaging is not permitted at this time (TJC
2016d). It highlighted several factors influencing its decision. For
example, compared to verbal orders which allow for a real-time two-way
discussion that allows for clarification of orders, texted orders would not
allow such synchronous real-time discussion. And it would likely add to the
burden on nurses (in our May 24, 2016 Patient Safety Tip of the Week “Texting
Orders – Is It Really Safe?” we noted that nurses would have additional
burdens due to more telephone tag and to physicians taking the shortcut and
avoiding having to input orders via CPOE). It also noted that clinical decision
support tools would not be directly available to the ordering physician and
that nurses entering the orders would need to track down the ordering physician
if clinical decision support messages popped up when they were inputting orders.
TJC reaffirms that CPOE is the preferred method for order entry.
The Joint Commission, in its clarification, recognizes that
“CPOE is increasingly available through secure, encrypted applications for smartphones
and tablets, which will make following this recommendation less burdensome.” It
then notes that when access to CPOE is not directly available verbal orders
would be an acceptable alternative, keeping in mind that verbal orders must
meet all Joint Commission requirements for verbal orders. We also encourage you
to look back at the recommendations in our
January 10, 2012 Patient Safety Tip of the Week “Verbal
Orders”. Keep in mind that some of the security issues (pro and con)
related to texting apply even more so to verbal orders. In particular, you
should have a mechanism in place to ensure the identity of the person phoning
in a verbal order. You’d be surprised how often staff at hospitals tell us they
identify the caller “because we know his/her voice”.
It’s been reported that vendors and patient advocates have
criticized this continuation of the ban following new Joint Commission and CMS
clarification of secure texting rules (Sutner
2016). It’s pretty clear why vendors of secure texting applications
would oppose continuation of the ban. But we don’t understand how patient
advocates would oppose keeping in place something that can prevent significant
patient safety risks.
We remain staunch advocates for use of advanced technology
to improve healthcare. Secure text messaging has numerous ways to improve
communication in healthcare and we advocate its use (for example, it can be
extremely useful in helping to prevent alarm fatigue). But texting orders
should not be allowed. We commend the Joint Commission’s decision to keep the
ban on texting orders in place.
References:
TJC (The Joint Commission). Orders – Texting. What is The Joint Commission's position on
texting orders? The Joint Commission 2016
TJC (The Joint Commission). Update: Texting Orders. Joint
Commission Perspectives 2016; 36(5): 15
http://www.jointcommission.org/assets/1/6/Update_Texting_Orders.pdf
TJC (The Joint Commission). Joint Commission Online. June 8,
2016
https://www.jointcommission.org/assets/1/23/JC_Online_June_8.pdf
TJC (The Joint Commission). Clarification: Use of Secure
Text Messaging for Patient Care Orders Is Not Acceptable. Joint Commission
Perspectives 2016;
36(12): 9 December 2016
https://www.jointcommission.org/assets/1/6/Clarification_Use_of_Secure_Text_Messaging.pdf
Sutner S. Joint Commission bans
CPOE secure texting for physicians. Vendors and patient advocates criticize
computerized physician order entry ban following new Joint Commission and CMS
clarification of secure texting rules. SearchHealthIT
2016; December 28, 2016
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