Barracks style STICU - Visitation, Phone Calls & HIPAA

[gambitlizard]

I work in an 18 bed surgical/trauma ICU. We are barracks style, meaning that only curtains separate each bedside. We are the state hospital and currently service the poor, uninsured, homeless and underserved. That said, we are having a difficult time determining how to institute HIPAA regulations about visitations and condition report phone calls.

We offer 5 visitations throughout the day. Most of our nurses adhere to this, and exceptions are made for special circumstances such as pre/post op, near death status changes, etc. However, some nurses feel free to allow visitors to remain at the bedside throughout the 12 hour shift. I believe this is a HIPAA violation, as any visitor can hear the details and goings-on at the next bedside (curtains, remember?).

Additionally, phone calls have become increasingly out of control. We use passwords to allow family/friends to call and obtain status reports. However, now we are often getting 10-20 phone calls in the course of a 12 hour shift. This limits time at the bedside. And most calls are asking, what I consider, trivial questions such as "how much of Daddy's lunch tray did he eat?" I don't mind giving an update, but I don't consider these things essential to patient outcomes. Additionally, administration has not been supportive by creating a policy re: passwords, phone calls, or visitor behavior.

HIPAA reads so vaguely.... we are allowed to release "limited information" based on our "professional judgement." For me, that means "stable, ventilated, sedated, no changes from previous status, etc."

I've read the other threads on this... but didn't find out what exactly HIPAA allows. Any thoughts are appreciated.

Thanks.

[Jolie, BSN]

It sounds like your problem is not so much HIPAA, but limit-setting regarding visits and phone calls.

Due to the unique set-up of your unit, allowing 24 hour visitation is not feasible. The nurses who ignore the visiting rules (other than the exceptions you mentioned) aren't so much violating HIPAA as they are creating a situation that imposes on the time and patience of their fellow staff. Same with allowing unlimited phone calls. In the NICU we allow information only to the mother and her partner. They are welcome to call as often as they like, but it is their job to share the information with everyone else from granny to the lawn man. We can't be expected to take unlimited time away from patient care to answer frivilous questions of anyone who happens to know the secret code number.

HIPAA recognizes that there are limitations to "privacy" in the healthcare setting. As long as you've done everything reasonable to protect privacy, such as closing the curtains, storing charts properly, not sharing information with unauthorized parties, you are not violating the law. It is understood that some incidental information may "escape" despite your best efforts.

[sicushells, RN]

We also set up a password at the bedside with the family after admission (which doesn't really protect patient privacy, because the control is completely taken out of the patient's hands, but Anyway...)

When I set the password up, I try to stress with the spokesperson that our preference is to interact with one person, two at the Most to optimize the time we spend at the bedside with their loved one. If I receive more than say... three phone calls from different people with the password, I reiterate on the phone that the spokesperson is so and so and that I'm unable to spend adequate time with my patient because I'm spending so much time on the phone. Usually as long as I bring the focus back to the patient and the care s/he's receiving the family/friends will be understanding. Don't get me wrong, there are always the difficult people, but most people will be understanding as long as I explain that my absolute #1 priority is the patient. Our day shift secretary is excellent and if she sees we're really busy, she'll ask them to call back later.

As far as HIPAA violations are concerned with the curtained bedspaces... I usually ask the visitors to step out during rounds and nursing report. We "suggest" that visitors come at certain times to avoid rounds and report, and we also reserve the right to have them step out during any procedure, emergency etc. Sometimes I've had family members say something to the affect of "Well the nurse yesterday let me stay while she straight cathed my grandma" to which I reply "Alright, the waiting room is over there, I'll call you when I'm done." We don't have actual visiting hours because Joint Commission disapproves (or so I was told by management...) Regardless, HIPAA doesn't restrict/limit or even care about visiting hours, as long as patient confidentiality is maintained. HIPAA really wasn't created to protect patient's privacy, it's really more of a vague side note (feel free to correct me if I'm wrong).

It sounds as if your unit is having some limit-setting issues with visitors and you're looking for legal documentation to back your policies up, but I'm not sure there is any.

[meandragonbrett]

In the unit I work in, we don't have a policy outside of HIPAA regarding telephone calls. The overwhelming majority of us will give nothing over the phone except: "The patient is critical/serious but stable. We only set up passwords for family members that are not local and cannot stay locally due to jobs, family situations, etc.

Regarding multiple phone calls: Usually at the 3rd phone call, I direct the caller to contact the patient's next-of-kin as I am A) Not able to give out information via the phone B) The more phone calls I receive the less time I am able to care for your loved one. That usually does the trick. After the 3rd family/friend/status phone call, I ask our secretaries to screen my calls for family and they then talk to them.