Bedside charting and confidentiality

[deespoohbear]

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.

[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.

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/Hipaa/RPPWeekspots.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

http://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/Hipaa/RPPHIPAAtoLife.html

How to Limit the Risks of PHI Left in Telephone Messages

http://www.aishealth.com/Compliance/Hipaa/RPPLimitRisks.html