Would Like Input - CABG - page 3

by NickiJules | 3,166 Views | 33 Comments

Can't stop thinking about my pre-op CABG... Any input would be greatly appreciated! My patient was admitted for recurrent CHF exacerbation, mostly having SOB that would come and go. So she was admitted, had positive cardiac... Read More


  1. 0
    Quote from psu_213

    Unfortunately nurses look at their patients charts "just to see what happened to them" and not necessarily as a learning experience.
    How could this be proven if a nurse was brought into question? I am genuinely curious because I have looked up patients the next day--recently to see if my patient who was stroking out got TPA after I finished my shift. I was looking at his labs and the MAR. This was a violation?
  2. 0
    But the OP IS learning from this. She would like to know what went "wrong" in this case and could it have been prevented?

    HIPAA (ahem) allows for PHI disclosure under the following circumstances:

    1. Treatment. Healthcare providers may share information about a patient for continuity of care.

    2. Payment. Any insurance/3rd party payer has the right to pt info so they can determine how much they will pay, charge for copays, determine what and what not was a covered service.

    3. Routine Healthcare Operations. This one is more vague, but one thing that does specifically fall under this heading is EDUCATION. Hence, the OP's situation. She is EDUCATING herself about how things could have gone differently in this situation. We've all had patients that ended up doing better or worse than expected. Instead of shrugging our shoulders and wondering, why not educate ourselves? We had case studies in school; each of our patients has the possibility of becoming a personal case study. As Esme so wonderfully put it- How else would we learn?
  3. 2
    Quote from Kunzieo
    But the OP IS learning from this. She would like to know what went "wrong" in this case and could it have been prevented?

    HIPAA (ahem) allows for PHI disclosure under the following circumstances:

    1. Treatment. Healthcare providers may share information about a patient for continuity of care.

    2. Payment. Any insurance/3rd party payer has the right to pt info so they can determine how much they will pay, charge for copays, determine what and what not was a covered service.

    3. Routine Healthcare Operations. This one is more vague, but one thing that does specifically fall under this heading is EDUCATION. Hence, the OP's situation. She is EDUCATING herself about how things could have gone differently in this situation. We've all had patients that ended up doing better or worse than expected. Instead of shrugging our shoulders and wondering, why not educate ourselves? We had case studies in school; each of our patients has the possibility of becoming a personal case study. As Esme so wonderfully put it- How else would we learn?
    Education for purposes of this discussion does not, alas, include self-directed and self-managed learning or recreational scholarship. It means participation in a bona fide educational program. Even if the OP were a student when she had this patient on the med/surg floor, she has no business peeking into the record when the patient is elsewhere; she can look at it again when the patient returns to her med/surg floor IF the patient is assigned to her then.

    Regardless of your opinion, if this is an electronic record, her electronic fingerprints are already all over it, showing date and time of her access. If the IT department and the RM department feel munificent they might not decide to whup her butt over it. If a state or national surveyor finds those fingerprints, they may not be so kind.
    psu_213 and Ashley, PICU RN like this.
  4. 1
    Quote from leslie :-D
    actually, it's the anesthesiologist that pretty much decides if pt is candidate for surgery.
    i am wondering where this pt is with her lung ca, as she very well may be candidate for hospice...
    and certainly not major surgery.

    it's too bad, as it 'sounds' like yet, another futile and invasive intervention for this person.
    may she soon find comfort and peace.

    leslie
    Wondering the same thing Leslie.
    tewdles likes this.
  5. 0
    Quote from psu_213
    Unfortunately nurses look at their patients charts "just to see what happened to them" and not necessarily as a learning experience.
    Looking at outcomes is part of learning.

    Again, some degree of the use of HIPAA is just reactionary. I'm not gonna wrestle anyone over though--I just think it a sad think that people can't learn. In the days before HIPAA, my colleagues, other doctors, and I learned a ton about patients through following them throughout their course in the hosptial--and through their previous records. I can't tell you the name of the person I learned X and Y over clnically speaking, but I do know that information helped us grow--and we have no idea who the people were to this day. For one thing, it's just too many patients & years, and B., there was a point where the holistic aspect of care was able to take a back seat while we looked at, well, the medical and pathological aspects of what transpired with them. Of course when they were in our direct care we employed both knowledge and a holistic approach. But there comes a time when you have to look at information and data objectively and scientifically in order to learn.

    Anyone that is just snooping so they can go back and tell someone, "Well you know what happened to Mrs. Z in ICU bed 3, . . .blah, blah, blah, isn't about learning or being professional.
  6. 0
    Quote from sandyfeet
    How could this be proven if a nurse was brought into question? I am genuinely curious because I have looked up patients the next day--recently to see if my patient who was stroking out got TPA after I finished my shift. I was looking at his labs and the MAR. This was a violation?
    To be honest with you, I'm not sure where the burden of proof lies. Do you have to prove that you were looking at the chart as a learning opportunity? Or, does the hospital, regulatory organizations, etc. have to prove that you were just 'snooping'?

    Our hospital is certified by TJC as a stroke center. When they come for our recertification, they comb through the charts of every pt that got TPA. The EHR will specifically name who opened the chart and when. When they look closely, I'm don't want my name on that chart hours or days after I was done caring for the pt. If I want to learn from what happened, I can go through the proper channels (our department education, the stroke APN for the hospital, etc.) to get access to the chart. It is not a wise decision to decide for me to go on my own to peruse a chart and call it a learning experience.
  7. 0
    Quote from samadams8
    Looking at outcomes is part of learning.

    I'm not gonna wrestle anyone over though--I just think it a sad think that people can't learn.
    I totally agree with both statements. However, there is a proper mechanism to look at an outcome to learn from it. Going on you own to look at a chart from days ago is not that proper mechanism.
  8. 0
    How the heck did this thread become about HIPPA violations?

    OP had a true concern and interest in learning about the outcome of her complex patient. That's what this is all about.

    I've done it too, OP, so the police can come get me too for a HIPPA violation. I've taken care of a critically ill cop who pretty much came back from the dead and I have asked police officers how he was doing.

    So, I am of the ultimate of all HIPPA violators for true care and concern.
  9. 0
    It is HIPAA not HIPPA. Sorry pet peeve.

    Technically, it can be considered a reason to ask someone why they accessed a patients chart. State surveyors don't really "see" the access records unless there are irregularities noted. Yes the records are routinely checked and computer readouts are given to the individual managers (in my experience) where follow up occurs. Your reason for looking into the record can't be that you were curious about your neighbor.......but checking on a patient the had been in your care during that hospitalization is usually an acceptable reason to access that record.

    However, I have worked at facilities that were......shall we say....zealous about the EMR and would even question me when I accessed a record for another facility ( with the release of records attached) and accessing the record when I assigned beds to appropriate floors......you need judicious about accessing record...a phone call to the unit would probably be a better choice.

    But....MOMRN is right the post is about the outcome of the patient that remains on the vent after a CABG. Lets stick to the topic
  10. 0
    If you're still on the upward swing of your career, you'll get plenty of learning experiences over time.

    Don't be nosey. Out of sight, out of mind. Next!


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