What are CNA's allowed to know? (HIPAA question) - page 3
by Donnagg123 | 13,476 Views | 35 Comments
Okay, I am curious if I am right or are other co-workers right. Are CNA's allowed to look in charts? I question this for two situations - one was a CNA who went to look in her grandmothers chart for information (curiosity... Read More
- 2Aug 6, '08 by missjennmbThere is such a huge difference between going into a chart because your mother's sisters friend's cousin's best friend... wants to know whats going on with that person and the question of the thread...
Why should a CNA not be able to understand their patient as a whole?? What if this patient was just told they have a terminal illness and only weeks to live? What if the patient was refusing to eat or acting off? CNAs would see this behavior before most others, and understanding that they are going through a rough period with their treatment would make it easier to put two and two together wouldn't it? IMO, information regarding anything communicable that a patient has been diagnosed with should be freely accessable to ALL those that have to care for the patient. Sure, universal precautions and all of that, but you should still know what to be careful of.
- 2Aug 6, '08 by Fruit_LoopI'm a CNA in a Texas nursing home. The CNA's and NA's are actively encouraged to read the charts if they have a free moment. This is especially important when we first get a new resident because OFTEN important information isn't passed along like it's supposed to be. There is far to little communication between the different shifts, and honestly I couldn't tell you where the care plans are located. The last time I saw them they were in the DON's office because she hadn't worked on them in 2 years and the Medicare survey team found them and freaked out. What I'm saying is that CNA's have to be able to cover what others are not doing for them. I can't even count the number of times we've been working and I've told aids they need to use better precautions because of potentially dangerous infections they didn't know about.
Also, we have several residents who ask us to call their families for them and the only place those numbers are located is in their charts. We don't hide what we're doing from the nurses and our level of service to the residents is certainly the better for their willingness to share. If I worked someplace and was told I wasn't allowed to know about the persons transmittable diseases I would walk out very quickly. The safety issues far outweigh the potential that one or two aids will break confidentiality.
Also, I work nights and have a limited amount of contact with most residents which limits my need to see the care plans. Usually I only have to know basic things like am I going to die if I go in without a mask or gown and how many people do I need to transfer them (or if they do it their selves). Since we sometimes only have one aid at night it means I have to drag the nurse away from what she's doing every time I need a question answered.Last edit by Fruit_Loop on Aug 6, '08 : Reason: added imformation
- 0Aug 6, '08 by NurseKatie08Quote from TiggerBellyIn the second job mentioned, where I was allowed and encouraged to look at the chart, it was because I was a student nurse and was there to learn as well as work. My position was slightly different that that of a CNA, because I was allowed to do simple dressings, d/c saline locks & various other skills that I had demonstrated competency on, as well as complete standard CNA duties like ADLs, vitals, etc. Direct caregivers were part of a three tiered system at this hospital--you were either a CNA, a Student Nurse I or a Student Nurse II. Depending on your position, you had a different skill set.But who encouraged you to look and was it legal? I never saw the need to look in a patient's chart. Anything questions I had regarding the patient's care could be answered by that patient's nurse. Anytime I had someone new, I would ask are they under any type of precautions? Any special diet, any orders regarding their mobility.
- 0Aug 6, '08 by Donnagg123Okay, first I think I need to clarify. I was not trying to make sweeping judgments on the CNA profession as a whole I was just talking about where I work. I am sorry if I offended some but it was not an attack on the CNA profession.
Was I saying that all CNA's gossip...NO. I have some very good CNA's but they as individuals tend to gossip...I was not making a wide spread judgement on all CNA's.
Also, I understand that CNA's care for residents and are very close to residents. But in our facility it is policy that the nurse call family etc. Also do I think CNA's are stupid and have NO knowlege base in nursing? ...a resounding NO. I just meant they are not licensed by the state to know these things.
I work in LTC, the care plans are not hidden, any charting they have to do is in an electronic system seperate from the nurses station, they all have "tickets" pieces of paper that are kept in a drawer with free access to all CNA's that list diet, mobility, etc etc. for all residents "in the system". Whenever there is someone new they are given report every shift of everyone so they can ask the CNA caring for them before them any questions or the nurse. Edited to add CNA's atour facility do not do vital signs, the nurse do. They do not do any treatments of any sort on the residents.
What I was asking is that aside from need to know information to care for residents (which they have plenty of other areas to access this information) are CNA's from a HIPAA standpoint allowed to look in residents charts? I hear of people getting fired all the time for HIPAA violation and ignorance of the law is not a good excuse (from a court standpoint). I am NOT trying to block CNA's from giving good care to our residents, I just want to make sure form a legal standpoint that I would be covered because I worked too hard for my license to have it taken away because of someone else. That is all.Last edit by Donnagg123 on Aug 6, '08
- 0Aug 6, '08 by Virgo_RNThe two examples in the OP are definitely violations of HIPAA.
At my facility, we have hard charts and electronic records. The electronic record has a CNA worklist, which is where the CNAs can go to find out what kind of diet the patient is on, whether they need to be ambulated or are on bedrest, if they are turn Q2, how often vitals are to be done, etc. CNAs do not have access to the patient's med list, labs, H&P, or imaging results, and there is no need for CNAs to look at the hard chart in order to do their job, therefore, it would be a HIPAA violation for them to do so.
- 1Aug 6, '08 by SharonH, RNQuote from Donnagg123are CNA's from a HIPAA standpoint allowed to look in residents charts?
Yes, they are.
I don't understand why you're even going there with the question. I've never heard of anyone else ever questioning it. People really make HIPAA too complicated. I am sure that the intention to protect patients' privacy was never to distinguish between levels of direct care providers and police exactly what this person and that person needed to know within the health care team needed to know.
Do you have a compliance officer at your facility? You most surely do. Check with them and then get back to us. I'll be surprised if they state that the CNA's couldn't look at the chart but I could be wrong. It's their job to know and I can learn something.Last edit by SharonH, RN on Aug 6, '08
- 0Aug 6, '08 by PipsqueakObviously, the scenario in the OP is a HIPAA violation for all the reasons already stated.
Now, if you're asking if CNA's in general are allowed to access the chart(for work related purposes), you might be better off checking your facility policy as this is something that seems to vary within facilities.
- 0Sep 7, '08 by pagandeva2000I guess it depends on the facility. Personally, I don't have an issue with aides reading a chart. They are doing direct care and can be affected by some things, in addition, it can be a great learning tool for them. If your facility has no issues with it, and the aides are not violating HIPPA compliance by telling others, I don't see an issue.