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:
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.
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
TJC (The Joint Commission). Joint Commission Online. June 8, 2016
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
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