I am writing this letter in response to the July issue’s editorial, “Scalpel, Stethoscope, iPad: The Future Is Now in the Intensive Care Unit.”1 I am concerned that it is implied that text messaging is an acceptable form of communication for the purpose of physician orders.
As a nursing leader, I strongly feel that effective communication is a cornerstone of patient and nursing safety. The Joint Commission does not recognize text messaged physician orders as an acceptable form of communication. Text messaging does not allow opportunity to read back and verify, as recommended by the Joint Commission.2 Critical clinical conversations may be missed by communicating by text messaging,3 and it does not provide an opportunity to converse with the provider to clarify orders. The Joint Commission states that institutions should establish a method of standardization for orders that are not written by the physician.2
Organizations should pursue policy changes that promote improved communication methods and address today’s technology. A solution to this nonstandardized form of communication is to encourage prioritizing computerized physician order entry (CPOE). This allows for direct entry of medical orders by the person with privileges to do so. CPOE systems facilitate safe, effective care for patients by insuring that clinical care directions and orders are communicated in a timely, accurate, and complete manner.4 Text messaging of orders does not have a signature attached to verify proof of the provider. A nurse could possibly accept a text message order from an unlicensed person, which would place his or her license at risk. CPOE allows for real-time authentication of physician orders.
Text messaging is not in compliance with the health insurance portability and accountability act (HIPAA) regulations and standards for encryption. Cell phones are usually personal property that people take home at the end of the day. Using your personal cell phone as a way to communicate patient information places you at risk of exposing patient information to people in the community, resulting in a HIPAA violation.5
It is important to establish institutional standards that make effective and safe communication a priority to protect the safety of the nurses and patients. Rather than identifying convenient ways of communication such as text messaging, we should move forward to a standardized method of communication that prioritizes the safety of the patient and meets HIPAA and Joint Commission guidelines.