Anyone An Hippa Expert Re: Hospital Staff Access To Charts?? - page 2

When I work at the hospital I sometimes see care partners and unit secretaries reading a patient's H&P. It's not necessarily a patient they're taking care of. Sometimes it seems like it's snooping... Read More

  1. by   KellNY
    Quote from Tweety
    CNA's sometimes need to look into a chart to clarify a diet order, activity status, or something like that. So to say CNA's have no business whatsoever in a chart, doesn't quite ring true.

    An example would be, a patient who is NPO is delivered a meal tray. The nurse might not be around, so the CNA checks the orders to see if it's changed. Or a patient during a bath says "the doctor says I can get in a wheelchair and leave the unit". Stuff like that.
    That's what I was thinking. And you know what? Nurses make mistakes, and I know there were a few times that I forgot to mention that a Pt was to be allowed clears after midnight (coming off an NPO diet) and the CNA was able to verify this by looking in the chart.
  2. by   Franksters
    Most of the NAs I work with wouldn't understand the docs orders/progress notes. I give my NA a detailed report tailored to the care she will need to provide. I don't compromise my patients' safety. If the NA is interested in learning, I explain things show her the chart, labs, radiology, what ever is appropriate to teach her why the person is here, why we do what we do and why her involvement is so important. I do not, however, allow them to read the charts "just because".
  3. by   KellNY
    Quote from Franksters
    If the NA is interested in learning, I explain things show her the chart, labs, radiology, what ever is appropriate to teach her why the person is here, why we do what we do and why her involvement is so important.
    Thank you for clarifying. This is a bit different from your original post.
  4. by   Cattitude
    Quote from franksters
    most of the nas i work with wouldn't understand the docs orders/progress notes. i give my na a detailed report tailored to the care she will need to provide. i don't compromise my patients' safety. if the na is interested in learning, i explain things show her the chart, labs, radiology, what ever is appropriate to teach her why the person is here, why we do what we do and why her involvement is so important. i do not, however, allow them to read the charts "just because".
    i could have written the above. where i worked, none of the cna's knew how to read the orders or even where the orders were in the charts. and to be quite honest, they weren't interested in labs or tests either. now if i ever had one that was a student as well, that was a different story..
    [color=#483d8b]
    [color=#483d8b]
  5. by   AdelaideChic
    Quote from casbeezgirlrn
    i've never in any hospital seen an aide reading a chart. not their business.
    [color=#483d8b]now in home care we don't even tell the aides what dx, of pt. is.
    so, if this person collapses, they do what? call am ambulance and say this person has collapsed, and cant even tell them their history? what about something like a diabetic saying they feel low, couldnt an aide encourage them to test and have some sugar (if they are indeed low), rather than waiting til they are unconscious and calling an ambo?
    maybe its different in australia, i worked as an aide in a nursing home and a hospital while i was going through uni, and i had access to all info, however i was directly assisting with these clients (in the nursing home i was actually a senior and medication credentialled, so it was integral that i knew diagnosis, but still, before i was doing meds, i still knew and felt i could provide better care because i knew the whole story, not just what i can see).
  6. by   Cattitude
    Quote from adelaidechic
    so, if this person collapses, they do what? call am ambulance and say this person has collapsed, and cant even tell them their history? what about something like a diabetic saying they feel low, couldnt an aide encourage them to test and have some sugar (if they are indeed low), rather than waiting til they are unconscious and calling an ambo?
    maybe its different in australia, i worked as an aide in a nursing home and a hospital while i was going through uni, and i had access to all info, however i was directly assisting with these clients (in the nursing home i was actually a senior and medication credentialled, so it was integral that i knew diagnosis, but still, before i was doing meds, i still knew and felt i could provide better care because i knew the whole story, not just what i can see).
    oh i know it sounds crazy but due to hipaa, we are not allowed to tell home health aides the dx. of pt's. however, we can maneuver that a bit by going over the care plan with them and telling them to monitor for certain s/sx. just not telling actual dx.

    unfortunately, at times some of our hiv pt's have become friendly with pt's and told them and then that aide quit. the ignorance surrounding hiv remains..

  7. by   AdelaideChic
    Ok, i can understand that, but what if the aide turns up for work, and the pt has slipped cutting a tomato, and there is blood everywhere, and the aide just instintly grabs a cloth and starts cleaning, and gets blood allover themselves in the process? Are they somehow alerted to the possiblity that this person has a blood-borne illness? I mean, sure dont go specific, witht he HIV lights flashing and all, but doesnt that person need to know in just a small way?
    Personally, i would love to work in the community in the future, in articular in palliative care which means i would come across a lot of different type of cases, but those that dont want to do it, are perhaps not the best person for that particular case? If someone doesnt want to be there, wouldnt there be someone who is more likely to be happier working there?
    I prob make no sense in this post :spin:
  8. by   KellNY
    Quote from AdelaideChic
    ...what if the aide turns up for work, and the pt has slipped cutting a tomato, and there is blood everywhere, and the aide just instintly grabs a cloth and starts cleaning, and gets blood allover themselves in the process? Are they somehow alerted to the possiblity that this person has a blood-borne illness? I mean, sure dont go specific, witht he HIV lights flashing and all, but doesnt that person need to know in just a small way?
    Universal precautions would eliminate most of the risk. You don't clean ANYONE'S blood without gloves.
  9. by   Cattitude
    Quote from adelaidechic
    ok, i can understand that, but what if the aide turns up for work, and the pt has slipped cutting a tomato, and there is blood everywhere, and the aide just instintly grabs a cloth and starts cleaning, and gets blood allover themselves in the process? are they somehow alerted to the possiblity that this person has a blood-borne illness? i mean, sure dont go specific, witht he hiv lights flashing and all, but doesnt that person need to know in just a small way?
    personally, i would love to work in the community in the future, in articular in palliative care which means i would come across a lot of different type of cases, but those that dont want to do it, are perhaps not the best person for that particular case? if someone doesnt want to be there, wouldnt there be someone who is more likely to be happier working there?
    i prob make no sense in this post :spin:
    being that i have an 86 year old with no risk factors infected with hiv, anyone truly can have it. if someone "doesn't want to do it" they shouldn't be in health care period.


    it can be the sweet elderly lady with chf or the first time mom, or the newborn. it can be the 5 year old or the 25 year old or the 85 year old. it can be your sister, your best friend, your neighbor. you can't pick and choose which pt's have it and who to take care of anymore. not to mention how many undiagnosed people there are out there. so yes, universal precautions take care of that.
    Last edit by Cattitude on Feb 11, '07 : Reason: added more
  10. by   SitcomNurse
    Quote from leannek90
    .... on her way to the nurses desk, she is reading all kinds of private information that is in the chart. How . Then she wants to chat about it!

    I just know that I wouldn't want just anyone to get ahold of my medical records and feel at will to read them!
    1. Susan , is that you? I told you to stop reading the charts!!!
    2. this same person would look up the hospital list, and look for names of persons she knew, scan their info to discern what they were in for, and even check the morgue listings.
    3. She then got on the phone to her friends and disseminated the information...
    You know Shari? her son was in the hosp last night, call her and call me back!

    I was so disgusted, I finally put in a report, and they bagged her in the computer listings of where you were and what you were doing.

    (An aside, this same person would call a local number, or even her own cell phone, to get a blank space of time, so she could rest her head, and say she was on hold. We snagged her with that one too... on hold NAPPING at the desk.)
  11. by   wooh
    Quote from casbeezgirlrn
    oh i know it sounds crazy but due to hipaa, we are not allowed to tell home health aides the dx. of pt's.
    that's not due to hipaa. if you're a healthcare worker involved in their care (it doesn't matter what kind of healthcare worker) you can know the diagnosis (and frankly, need to know if you're going to provide decent care.) i think saying they don't need to know because "they wouldn't understand anyway" is just underestimating their intelligence, and almost a power trip by nurses to withhold information.
  12. by   canoehead
    Quote from SitcomNurse
    (An aside, this same person would call a local number, or even her own cell phone, to get a blank space of time, so she could rest her head, and say she was on hold. We snagged her with that one too... on hold NAPPING at the desk.)

    Now that's a good one, I need to remember that...

    Know what you do when someone catches you napping on the job? Close your eyes again briefly, and say "Amen."
  13. by   Tweety
    Quote from casbeezgirlrn
    i could have written the above. where i worked, none of the cna's knew how to read the orders or even where the orders were in the charts. and to be quite honest, they weren't interested in labs or tests either. now if i ever had one that was a student as well, that was a different story..
    [color=#483d8b]
    [color=#483d8b]

    our cnas are literate and for the most part now how to read things "regular diet", bedrest and such. i'm surprised a cna hasn't read your post and flamed you back because it's a little insulting.

    where i work they aren't interested in labs, tests, meds etc. either and they don't need to know that to perform their job.

    most of the time they aren't in the main charts. we have bedside charts that where we keep a detailed report that includes things the cna needs to know to provide care such as diet, activity level, and yes diagnosis because it would be nice to know that the patient had a bowel resection if they are going to be getting them up. but as i said, sometimes things change during the day and the nurse hasn't changed the bedside report, or isn't around for the cna to ask, and they are allowed to go to the main chart, where they have the common sense to find doctors orders and read if something has changed they need to know.

    all things aside, it doesn't take a rocket scientist to know that if a cna or anyone picks up a chart just to be nosy they are violating hippa.

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