charts on plain sight--HIPAA violation?

[cebuana_nurse]

Just wanna vent, we just hired a new nursing home administrator (who has no previous nursing home experience)started this new idea of nurses having to answer call bells in their assigned halls. I have 2 aides in 30-bed hall who answers these call bells. I don't mind helping out to boost someone in their bed or get their water pitcher and whatever crap but this is insanely ridiculous. Nurses have already too much in their hands. On top of that, she ordered that all of the charts to be out in plain sight, where our desk is so that we could attend to our residents and families' needs. We used to do our charting in the back room of the nurses station, now the only person that is allowed to be in there is the clinical director and the unit secretary. All the nurses should be out at the desk to answer phone calls, do your change-of-shift reports, do admissions, carry out orders and etc. I don't think this is a good idea. Being interrupted or distracted increases the risk of committing mistakes especially doctor's orders. The desk in the station has so much stuff around it like paperwork so we don't have enough space to use. And when its a weekday, all members of the healthcare team gather around the desk to do their notes leaving no space for nurses to sit down and chart. Plus we don't have a fax machine in our hall so we have to run down to the other wing to fax all our orders to pharmacy. Our cordless phones are not working so when you're down the hall, you have to come up to the station and answer these phone calls. I can't believe that there are people around there that doesn't take a quick second to answer these calls because they believe that its not part of their job description. I understand that we are understaffed but it doesn't mean that the nursing department have to carry all the burden. Its sad to see that there are nursing aides that left this facility because of always being understaffed. Sorry this was long..

Now my question is, is this allowed (the charts being in plain sight)? I don't feel comfortable giving report to an incoming nurse when other people could hear it. Their medical condition is confidential and non-employees doesn't have to hear about it. If this is a violation, can I get a link for this fact?

[itsmejuli]

Our charts are kept at the nursing station, all closed and on a shelf. We do our charting and other paperwork at the desk. We give report privately at the med cart. We all do our best to maintain patient privacy and confidentiality.

[PedsAtHeart, LPN]

I agree with the itsmejuli.

When I worked LTC the charts were all kept at the nurse's station. Charting was done at the nurse's station, or a nearby table, or the med cart.

I see nothing wrong with this. You need to be readily available if you are needed.

[wee_oneRN]

Try to see it from a different viewpoint. Change is always difficult at first, but ask yourself what is the administrator trying to accomplish? From what you have described it sounds as if she is trying to make the nurses more accessible to patients, family, staff and other healthcare providers by encouraging more rounding and maintaining visibility. Try to understand the reasoning behind the change and work with her to find the best ways for your facility to accomplish this.

In most healthcare settings (in the hospital I work at, and in LTC previously) charts are out and not behind a door. These charts are never left open for others to see, however.

As for nurses being the ones to answer call-lights, perhaps you can make an arrangement where nurses and other staff take turns? In a hospital I worked at we had hourly rounding, and the nurses and CNA's would take alternate hours.

[grandmawrinkle]

Hospital RNs don't get to sequester themselves in a back room and have the NAs run the floor. They are also subject to 10 million interruptions in their documentation in the interest of patient care. That's the way nursing is; multitasking more or less has to be a way of life. I also think it is a good idea for you to answer some of your own call lights if you can. Whether this is realistic or not with your staffing I don't know, but it really isn't a bad idea. It sounds to me like you just don't want to be interrupted when you do your documentation and are trying to make HIPAA part of your excuse. If your new DON doesn't have any LTC experience, it sounds like she probably does have hospital experience and is making some good and necessary changes to me. Nurses need to be available for patients.

As long as charts are kept behind a desk in a rack and not wide open in a public area, there is no HIPAA violation. As long as you aren't giving report on different patients in one patient's room and are reasonably out of the earshot of family and/or they don't know who you are talking about, it's not a HIPAA violation.

[Kashia, ASN, LVN]

Really, who has time to notice such al thing? Do you think charts should be put far out of the way so already busy nurses

have to walk farther to get to them?

I would hope you could put your efforts into something more productive, like how miserable nursing is becoming.

Or the elite taking over our country and taking our freedoms away.

Sorry for my rant but I just think there are bigger fish to fry...

we have lost our common sense!

Laws and regulations are suffocating us!

[Esme12, ASN, BSN, RN]

The charts may be out in the nurses as long as there are not identifiers. Patient initials,MD and Room are acceaptable. As far as giving report in the nurses station it is completely acceptable and family need to be politely asked to remain in patient rooms. Report needs to be kept to a low roar. Joint Commision favors the model of "walking rounds" where the off going and on comming nurse give report room to room and in front of the patient when new orders and plan of care is discussed. I believe it was Mayo clinic or Cleveland Clinic set the standards (I can't remember right now) and made the model for walking rounds. Nurses hate change but changes will come. I has been documented that with this format of walking rounds errors and missed orders had dropped dramatically.......both nurses look at the orders during report to limit errors. It sounds that you have some obstacles to overcome, ask the director to move the fax machine. Request a meeting to talk about how to get around the obstacles. Show her you are willing to change and show her you are bright enough to come up with a plan to make it work! BUt her plan is all perfectly legal and acceptable.

[I<3H2O, BSN, RN]

I think Esme12, Grandma Wrinkle, and theVWgirl all have very good points! Change is very hard on everyone but there has to be a reason behind it. This new director, I'm sure, isn't coming into this new facility wanting to be hated but instead wanting to do the best for the patients. If you have 3 people answering 30 pts call bells that is 10 pts each instead of 15 each for the 2 CNAs. Granted, these residents are in their "homes" and may not need as much "care" as an acute care pt. but if I had to answer call bells and toilet 15 ppl I'd be going crazy. CNAs work their tail end off and I think it is acceptable to have you assist with answering the call bells too.

This comes from an RN who has never worked LTC. It is my understanding that in MANY LTC facilities the nurses chart very infrequently, have med aides to pass meds or at least assist with them, etc. Perhaps I am looking at the request from your new director as something very doable when in fact it is not. A few questions to ask yourself, "am I TRULY so busy during the day that I cannot assist with call bells and walk to the back for charts? Will doing this cause me to be staying after my shift to complete my tasks?"

I hope that you will welcome this change as positive, I am sure your CNAs do! I hope you are able to utilize this time to better care for your residents.

[NotFlo]

This comes from an RN who has never worked LTC. It is my understanding that in MANY LTC facilities the nurses chart very infrequently, have med aides to pass meds or at least assist with them, etc. Perhaps I am looking at the request from your new director as something very doable when in fact it is not. A few questions to ask yourself, "am I TRULY so busy during the day that I cannot assist with call bells and walk to the back for charts? Will doing this cause me to be staying after my shift to complete my tasks?"

Just FYI...many states do NOT utilize med aides. Mine doesn't. The nurses on the LTC floors at my facility have 30 people to pass meds to by themselves, in addition to treatments, answering phones, writing and noting orders, calling MDs, ordering meds, keeping the med and tx cart stocked and of course dealing with family members.

Also, at my facility the LTC nurses do have quite a bit of charting to do.

I work the rehab floor...I "only" have 15 pts but they are short term medicare pts. I have to chart on every single one of them every single day, in addition to being responsible for all of the above plus.

[NotFlo]

No, having charts at the nurses' station closed on a rack (or open behind the desk when someone is working on them) is certainly NOT a HIPAA violation. I can't even imagine working someplace where the charts were kept in a backroom somewhere not within easy reach. We are in and out of the charts constantly all day long.

I have never heard of or seen a LTC/REHAB that keeps charts in a back room somewhere. I have never had the "luxury" of hiding out to chart. People are constantly needing to ask the nurse questions, I can't imagine not being accessable throughout the shift.

Call bells are everyone's responibility. I doubt the admin. wants ONLY nurses to answer every call light, she just wants everyone pitching in.

I DO have a pet peeve regarding other departments being at the nurses' station all day. ALmost all of these people have their own office, their own desk, their own computer, and are only on their feel a fraction of how many hours I am...therefore, they need to move when I finally get the chance to sit and chart. I will absoloutely tell people that (in a very nice way) if I need to.

[canigraduate]

At the LTC where I used to work, this was standard practice. The nurses, aides, unit manager, and unit secretaries all had joint responsibility to answer call lights. Nurses usually either did their charting at the desk or in the break room, which was right next to the desk where they could still hear call bells.

[pielęgniarka, RN]

We have pager systems for our call lights. At the LTC I work at the NAR's are the expected to be the first ones responsible for answering call lights-- they get the page the minute the resident's button is pushed. If after 2 min., the NAR's didn't get to the light it goes to the nurse's pager that is working the cart and they need to check it out. If after 10 minutes it's not answered it goes to a nurse manager's pager, then there's hell to pay. We all work together to answer call lights.

Our charts are kept centrally, at the nurses desk, organized with only a room number on display. To give report to the oncoming nurse, we go into the med room if the hall is busy to keep confidentiality. Otherwise report is quietly given at the nurses desk. The nurses desk has a privacy panel on it so not everyone walking by can see what we are writing or typing.

Hope this helps!