Bedside charting and confidentiality

  1. Our manager wants us to start doing our flow sheets at the patient's bedside. I am not really hip on this idea, but I suppose I would adjust. The one thing I am having trouble dealing with is the fact that the flow sheets are going to be stored on clipboards in the patients' rooms in a folder holder. I really think this is going to cause some confidentiality concerns. My DON doesn't think so but I can't imagine having the flow sheets in plain view. I work at a small hospital in a small town where everybody wants to know everyone's else's business anyway. For the past year all we have heard in about the new HIPPA regs and patient privacy. Not to mention our wonderful friends at JCAHO.:roll These flow sheets have the patient's name, DOB, SSN, insurance info, plus the nurse's notes for the past 24 hours. If that is not a breach of privacy, what is? Our DON says that some hospitals have the whole chart in the patient's room and she says she doesn't foresee a problem. I have had patient's family's grab the chart out of the nurse's desk and open them without even asking, so I am sure if they are in the room in plain sight they will be looked at. I am just wondering what other facilities do in regards to bedside charting and keeping the patient's chart (partially or whole) in the room.
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  2. 12 Comments

  3. by   fergus51
    We do bedside charting in L&D. It is a binder stored in a locked drawer in the room, with other supplies. I find it easier than assessing and then going to the nurses' station to chart, plus it keeps nurses near the patient where they belong. I just hate it when we lose a set of keys!!! I can't imagine leaving it out in the open, especially with all the identifying info (like SSN especially!) on it.
  4. by   SmilingBluEyes
    It needs to be LOCKED up in the room, away from prying eyes and nosy minds. I think a hospital could get into BIG TIME hot water over this potentially huge breech in confidentiality. Dangerous territory they are going to tread....
  5. by   canoehead
    We have clipboards with just that day's flowsheets on them and rarely have any trouble. There is a sign on each clipboard saying the info is confidential and not for visitors to look at.
  6. by   Sleepyeyes
    There is a sign on each clipboard saying the info is confidential and not for visitors to look at.

    ahhh...what better way to attract a nosy visitor while the pt is too sedated to object....
  7. by   fedupnurse
    Put in a call to risk management, JCAHO, etc and find out what the regs are for your state. I know JCAHO has a website with the ability to ask questions. They also, I believe govern HIPPA. I would not leave anything in a patient's room unless it was locked up. You wouldn't believe the sight see'ers we get. Maybe because we live ina summer resort area and people have that tourist mentality, but near strangers of people come in professing to be "their best friend of 20 years" and when they leave the patient says "haven't seen him in 20 years wonder why he chose to visit now?" I have to constantly remind my colleagues who are new to this sport that they cannot tell just anyone information. If someone calls or comes to the desk ask their name and check to see if they are the contact person. If they aren't I refer them to the contact person. If they are really close to the patient, they should know the contact person as well and know their phone number. Other than that I keep it very superficial and vague by saying "I'm sorry but I am not allowed to discuss _____'s situation due to patient confidentiality". A colleague had a doctor relative of her patient berating her for not giving him information. She said "If you really are a doctor you should know better. I have no way of verifying if you are entitled to this information." He called back insisting on speaking with the medical resident who told him the same thing.
    If your manager insists just say "If all the other hospitals had their managers jump off a bridge would you do it too???????"
    Document your concerns in writing if you are told you have to do it. Anything I document always goes to risk management as well.
    Good luck.
  8. by   SmilingBluEyes
    Ditto sleepyeyes...how will you defend yourself IF a pt's confidentiality IS breeched if and when a "problem" presents itself? better by far, to head it off before it happens. pt charts and records must be guarded carefully, period. just cause no one had breeched this yet, does not mean it won't happen. :stone
    Last edit by SmilingBluEyes on Jun 9, '02
  9. by   disher
    deespoohbear, Hospital policy should treat the personal information of their patients with the same respect that they, as individuals, would like their own personal information to be treated. Ask your DON if she would have a problem with visitors knowing she had a large formed bowel movement?
  10. by   Huganurse
    We were not given demerits by JCAHO for bedside flow sheets. They only had the I/O's on them and nothing more. It was a way for us to communicate. The aids charted BM's on the sheet. They were hung on the back of the shared bathroom door. No visitors were allowed to use the patients BR. If you are talking about full nursing note flow sheets then I prefer to keep them in the nurses station. Many hospitals I've worked in have charting stations/boxes just outside the door in the hall. I don't care for this either as it makes the hallway very congested and the nurses have to keep an eye on who's in the charts. I've seen family members going through them when they have access to them. Inside the nurses station is truley the only way to keep confidentiality IMO.
    Locking them up in the room is very inconvenient and I can see myself leaving them open b/c I don't have time to mess with a lock every time I want to chart. (I chart as I go) I'd hate to be the nurse in a emergency situation trying to open a worn malfunctioning lock to get at the chart.
    Why can't you just carry your flow sheets on a clipboard? If someone wants to see them they'll just have to find the nurse who is the one with them and needs that info on an ongoing basis anyway.
  11. by   deespoohbear
    I figure that if the our manager insists on doing this, I will just keep my patient's flowsheets on a clipboard at the nurses's station. At the end of my shift, I will hand them over to the oncoming nurse. I figure if the hospital wants to be stupid about this, let them. Sometimes the administration just has to learn the hard way that nurses do know what they are talking about.
  12. by   SmilingBluEyes
    that is what i do, deespoohbear. i have the flow sheets behind the nurses station and when i go into my patients' rooms i take em w/me and fill em out and then put them back. it works for me.
  13. by   NRSKarenRN
    HIPAA Privacy officer reporting for duty.....

    Won the "prize"of going to a 4 day HIPAA training in February
    "cause you know computers and confidentiality standards, can earn how to fill out this HIPAA form, and only one really available that can be released from office". Now I'm Privacy co-chair for entire Health system and responsible for HIPAA Privacy review in my agency (completing next week). See what happens when you say you moderate an allnurses forum???

    Check out these topics of interest. HIPAA rules fall under the Office Of Civil Rights for sanctions... haven't seen them in my hospital/health facility in a LONG time. See Privacy story's -- what we want to prevent then check out the FAQ first as it gives overview of regs.

    Medical Privacy Stories
    http://www.healthprivacy.org/usr_doc/43842.pdf

    July 6, 2001 HIPAA FAQ:
    HHS first set of guidance to answer common questions and clarify confusion about the final rule's provisions. http://www.hhs.gov/ocr/hipaa/finalmaster.html

    from above site---
    Q: Do the minimum necessary requirements prohibit covered entities from maintaining patient medical charts at bedside, require that covered entities shred empty prescription vials, or require that X-ray light boards be isolated?

    A: No. The minimum necessary standards do not require that covered entities take any of these specific measures. Covered entities must, in accordance with other provisions of the Privacy Rule, take reasonable precautions to prevent inadvertent or unnecessary disclosures. For example, while the Privacy Rule does not require that X-ray boards be totally isolated from all other functions, it does require covered entities to take reasonable precautions to protect X-rays from being accessible to the public. We understand that these and similar matters are of special concern to many covered entities, and we will propose modifications to the rule to increase covered entities' confidence that these practices are not prohibited.
    ----------

    The words "resonable precautions" is key here. Clipboards at bedside are permissionable just need coversheet to minimize prying eyes. Would make reasuable coversheet simple to avoid temptation eg:
    PHI 3 South (area)
    Rm # ______

    down bottom place: Facility staff use only. (warning statement...don't make obvious; no doctor info on sheet)
    p.s.:PHI-accronym for Protected health information.

    This coversheet meets the standard for reasonable precaution---charting cabinet outside door or placing clipboard inside treatment abinet in room an additional step---but not always feasable in cash strapped 75 year old hospital.

    Other things staff nurses can do to minimize privacy breaches:
    1. Never share your password to computer system. If facility uses large amts temp nursing staff should have password available just for these workers for computer access.

    2. Log off before leaving computer..even for few seconds. Computer should have screen saver turn on for inactivity 30-60 seconds. Computers not placed in open view of hallways. Use computer screens ..placed recessed m turned away from public view.

    3. Pull curtain between patients when conducting patient admission interviews. Ask pt who does he want as his emergency contact and can facility release clinical information to them. If sensative topic to be discussed eg SW financail eval for nursing home placement, rape counseling etc, is there a conference area that interview can be conducted in or could roomate be taken out of room??

    4. If speciman labels with patient info left in pts room above bed, place in white envelope not clear one so visitors can't read info.

    5. White boards last name; treating staff first name or initials only

    6. Sign in sheets name only, avoid listing dr to be seen to prevent linking doc with specific medical problem.
    ---------

    Protecting the Privacy of Patients' Health Information, HHS Fact Sheet, 7/6/01
    http://www.hhs.gov/news/press/2002pres/20020321.html


    HIPAA Compliance Strategies
    Target Behavior to Plug Weak Spots In Seven Vulnerable Privacy Areas
    http://www.aishealth.com/Compliance/...Weekspots.html

    Privacy Reminders, Technical Changes Help System Protect Health Information
    http://www.aishealth.com/Compliance/Hipaa/12tips.html

    Tips for Protecting Faxes Under HIPAA Privacy Rule
    http://www.aishealth.com/Compliance/Hipaa/FaxTips.html


    Standards for Privacy of Individually Identifiable Health Information
    http://www.hhs.gov/ocr/part1.html

    Student Nurses Pose HIPAA Challenges: De-Identification, Minimum Necessary
    www.aishealth.com/Compliance/ Hipaa/RMCStudentnurses.html

    Bring HIPAA to Life With Patient Scenarios That Plot the Permitted Flow of PHI
    http://www.aishealth.com/Compliance/...PAAtoLife.html

    How to Limit the Risks of PHI Left in Telephone Messages
    http://www.aishealth.com/Compliance/...imitRisks.html
  14. by   3rdcareerRN
    I am resurrecting this old thread to refresh everyone about the great list of HIPAA links below, and add a new one:

    FAQs about common situations re. HIPAA, from the government office responsible for enforcing it --

    For healthcare providers:
    http://www.hhs.gov/ocr/hipaa/provider_ffg.pdf

    For patients and families:http://www.hhs.gov/ocr/hipaa/consumer_ffg.pdf

    Spend just 5 minutes looking over the preceding material--you'll save yourself hours of worry.


    Quote from NRSKarenRN
    HIPAA Privacy officer reporting for duty.....

    Check out these topics of interest. HIPAA rules fall under the Office Of Civil Rights for sanctions... haven't seen them in my hospital/health facility in a LONG time. See Privacy story's -- what we want to prevent then check out the FAQ first as it gives overview of regs.

    Medical Privacy Stories
    http://www.healthprivacy.org/usr_doc/43842.pdf

    July 6, 2001 HIPAA FAQ:
    HHS first set of guidance to answer common questions and clarify confusion about the final rule's provisions. http://www.hhs.gov/ocr/hipaa/finalmaster.html

    from above site---
    Q: Do the minimum necessary requirements prohibit covered entities from maintaining patient medical charts at bedside, require that covered entities shred empty prescription vials, or require that X-ray light boards be isolated?

    A: No. The minimum necessary standards do not require that covered entities take any of these specific measures. Covered entities must, in accordance with other provisions of the Privacy Rule, take reasonable precautions to prevent inadvertent or unnecessary disclosures. For example, while the Privacy Rule does not require that X-ray boards be totally isolated from all other functions, it does require covered entities to take reasonable precautions to protect X-rays from being accessible to the public. We understand that these and similar matters are of special concern to many covered entities, and we will propose modifications to the rule to increase covered entities' confidence that these practices are not prohibited.
    ----------

    The words "resonable precautions" is key here. Clipboards at bedside are permissionable just need coversheet to minimize prying eyes. Would make reasuable coversheet simple to avoid temptation eg:
    PHI 3 South (area)
    Rm # ______

    down bottom place: Facility staff use only. (warning statement...don't make obvious; no doctor info on sheet)
    p.s.:PHI-accronym for Protected health information.

    This coversheet meets the standard for reasonable precaution---charting cabinet outside door or placing clipboard inside treatment abinet in room an additional step---but not always feasable in cash strapped 75 year old hospital.

    Other things staff nurses can do to minimize privacy breaches:
    1. Never share your password to computer system. If facility uses large amts temp nursing staff should have password available just for these workers for computer access.

    2. Log off before leaving computer..even for few seconds. Computer should have screen saver turn on for inactivity 30-60 seconds. Computers not placed in open view of hallways. Use computer screens ..placed recessed m turned away from public view.

    3. Pull curtain between patients when conducting patient admission interviews. Ask pt who does he want as his emergency contact and can facility release clinical information to them. If sensative topic to be discussed eg SW financail eval for nursing home placement, rape counseling etc, is there a conference area that interview can be conducted in or could roomate be taken out of room??

    4. If speciman labels with patient info left in pts room above bed, place in white envelope not clear one so visitors can't read info.

    5. White boards last name; treating staff first name or initials only

    6. Sign in sheets name only, avoid listing dr to be seen to prevent linking doc with specific medical problem.
    ---------

    Protecting the Privacy of Patients' Health Information, HHS Fact Sheet, 7/6/01
    http://www.hhs.gov/news/press/2002pres/20020321.html


    HIPAA Compliance Strategies
    Target Behavior to Plug Weak Spots In Seven Vulnerable Privacy Areas
    http://www.aishealth.com/Compliance/...Weekspots.html

    Privacy Reminders, Technical Changes Help System Protect Health Information
    http://www.aishealth.com/Compliance/Hipaa/12tips.html

    Tips for Protecting Faxes Under HIPAA Privacy Rule
    http://www.aishealth.com/Compliance/Hipaa/FaxTips.html


    Standards for Privacy of Individually Identifiable Health Information
    http://www.hhs.gov/ocr/part1.html

    Student Nurses Pose HIPAA Challenges: De-Identification, Minimum Necessary
    www.aishealth.com/Compliance/ Hipaa/RMCStudentnurses.html

    Bring HIPAA to Life With Patient Scenarios That Plot the Permitted Flow of PHI
    http://www.aishealth.com/Compliance/...PAAtoLife.html

    How to Limit the Risks of PHI Left in Telephone Messages
    http://www.aishealth.com/Compliance/...imitRisks.html

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