Family looking through patient chart?(Sorry, kind of long...)

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I am contracted out (self-employed) by this staffing agency as a private duty nurse. In the home we have a patient chart that looks like a typical chart in the nursing home. It has a plan of care, doctor's orders, MAR's, etc.

Well...this patient happens to have a relative who has recently moved to the area and is a big shot DON at a nursing home (at least, she "perceives" herself to be a big shot.) I met her one time and had to give her the attitude right back that she gave me and I hope I never have the misfortune of meeting her again. Anyway, the patient had a sinking spell/TIA and the day nurse on duty told me what happened with this relative and is worried and upset over it and I would just like to know if what I'm thinking is right.

The hot shot relative somehow caught wind that the ambulance had been called for the patient (according to the day nurse the relative was on her way to work--at app. 10am--and saw the ambulance in the driveway) and rushed over there. It's being toned down and putting it nicely to say this relative is a know-it-all and a snob. So, the relative runs in the house and takes over, ordering the day nurse to give her the MAR so she can see what this patient is taking. This patient takes meds all through the day (for ex. 9am, 11am, 2pm, 5pm, etc.) and when the day nurse pulled the 9am meds she went ahead and pulled the 11am meds, set them aside in a cup and signed them out on the MAR.

So, the hot shot grabs the MAR and when she sees that the 11am meds have been signed for she starts screaming at the day nurse, makes a big scene for the medics and all the world to see (you know, so everyone can see what a super nurse she is), saying things like don't you realize you could lose your license over this?

I have also heard this supernurse has read through nurse's notes when she comes to visit the patient.

Personality issues aside, is it in accordance with privacy laws and such for people (even family, and BTW, she isn't a child or grandchild) to look through patient charts when they have not been contracted out by this company to be involved in her care? It just doesn't seem right to me.

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Specializes in Medical/Surgical, Cardiac/Telemetry.

I'm only a student, but we've been told to never chart for care or anything else ahead of time. If anything would happen, it would be exactly what a lawyer would look for.

As to the nurse/relative viewing the careplan, I'm not really sure about this. Are you thinking it's violating HIPAA? Her attitude aside, wouldn't it be dependent on if she has permissions of the patient? I'd like to know what others have to say about this as well.

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Specializes in Multiple.

There seem to be several issues here:

  • All this is hearsay - you did not witness this yourself and you don't know the full facts - be careful what blame you apportion without knowing the full facts.
  • Attitude to staff by relative- it stinks and no matter how much she was concerned, she should behave more professionally
  • Signing off meds - always a no-no unless they have been given. Why sign if you haven't given them? Is it safe to leave meds lying about for over an hour in an open cup? I think not...
  • Reading the notes of the patient - this is dependent upon who has permission - patient may have given it. 'supernurse' as you call her may have power of attorney and be next of kin, and exactly who has violated privacy - was it the nurse who left them lying around or the relative who read them or both - you need more facts to be able to answer the queries you pose.

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Yes, it's a HIPAA violation if the pt (or POA if the pt is not competent) never gave permission, however she was right in that pulling the 1100 meds early and signing them off is not a good thing. At 0930, if something happens to the pt and it look like the 1100 meds were given, she wouldn't have a leg to stand on. I know this has been debated here before, about whether or not to sign off meds when they're taken out but not yet in the pt's mouth or whatever route they're given, but basic Nursing 101: never sign off anything you haven't done yet.

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Specializes in Utilization Management.

At the hospital, even the POA cannot read the chart unless it is with permission (and sometimes in the presence) of the doc. This is because just reading the chart can cause misinterpretation.

I realize that everyone else thinks pulling the meds early is a big no-no, but in our hospital we have a certain "leeway" time in which we can pull the meds. So for instance if your med is due at 1100, it's OK to pull it at 1000. Signoff is not done until the med's actually given, however, and that could've been a problem.

Bigshot DON does sound like she has an attitude problem. It was, at the very least, unprofessional of her to come in and reprimand the nurse (who is not her employee).

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
yes, it's a hipaa violation if the pt (or poa if the pt is not competent) never gave permission, however she was right in that pulling the 1100 meds early and signing them off is not a good thing. at 0930, if something happens to the pt and it look like the 1100 meds were given, she wouldn't have a leg to stand on. i know this has been debated here before, about whether or not to sign off meds when they're taken out but not yet in the pt's mouth or whatever route they're given, but basic nursing 101: never sign off anything you haven't done yet.

i agree with both of your points -- it's a hipaa violation, and meds shouldn't be signed off before they've been given. but perhaps the biggest point of all is that this relative is a pain in the patoot, and if she weren't the other things probably wouldn't be such a big deal.

let that be a lesson to all of us -- when our relatives are patients, let's be calm, professional and personable!

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Specializes in nursery, L and D.
At the hospital, even the POA cannot read the chart unless it is with permission (and sometimes in the presence) of the doc. This is because just reading the chart can cause misinterpretation.

Gotta disagree with you on this point. At least in my state, your medical chart is yours. You, and whomever you deem, may read your chart at anytime. No doctors "permission".

As for actually taking a paper chart, you have to pay for the copies, and sign the paperwork.

It might be a good idea to say to someone who wants to see their chart "why don't I get the doc in here and he can help you understand it better"........but you can't deny them their chart if they ask.

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This relative is not a POA. Also, this patient has 12 children and many of them do not like this relative, and one became very upset that the nurse was talked to this way, because this nurse has been caring for this patient for two years. I know this to be true.

But again, personality issues aside, I have a lot of trouble with the idea of just anyone coming into the home, for example, and being at liberty to look through the patient's chart. Private duty nursing is different in a lot of ways than hospital nursing, even though basic principles apply. Technically, the nurse should not have signed out a medication until it was taken, but she has her system and it has worked for her for two years, she is working under her own license and furthermore this woman had absolutely no business saying ANYTHING to this nurse.

This patient also has a diagnosis of Alzheimer's and is not capable of making important decisions so I can't believe that, even with the patient's consent, the patient would be competent enough to give permission to another person to go through her chart. If HIPAA ever served a purpose I would think it would apply here. It seems odd to me that the relative of a patient, POA or not, could simply walk to the nurse's station in a hospital and pick up the patient's chart and start looking through it. Seeing as the chart contains confidential and legal documents I would think you would need a court order? Especially considering that to the average lay person a lot of what is found in a patient's chart would not make sense to them and could be misinterpereted. Even if they did understand the chart what might stop an unscrupulous person from altering a document and then using it against the facility? And the deal about anyone being able to look at a patient's chart with their permission doesn't sit well with me. What if an attorney showed up at the door and said I think we have a good case, I just need to look at your chart, may I?

Just doesn't seem right....

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Criss, my experience has been that pt and families can read charts while the pt is in house only with the doc's permission or presence, to interpret. If the pt is no longer in house, it's done in medical records and the doc is not needed.

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Specializes in icu, er, transplant, case management, ps.

The only person who has the right to have access to the chart is the patient or the person holding a duly appointed Power of Attorney. No other member of the family has any right to read the chart unless the patient grants them written authorization. As for reading the patient's chart while hospitalized, the chart is the patient's record and he/she has the right to read it. That being said, hospital administration will attempt to delay access by putting all sorts of demands on the patient, including having another person, from the hospital present, and will charge for that person. If a patient wants copies of his hospital record, the hospital can charge normal and customary fees for duplication of the record. It generally runs from $1 to $3 a page. Hospitals will frequently withhold the chart claiming the record is incomplete.

Woody:balloons:

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What if an attorney showed up at the door and said I think we have a good case, I just need to look at your chart, may I?

lawyers do show up and look at patient files - I remember this happening in psychiatry

- and yes, a patient's family member might alter documentation - I experienced this re: flow sheet left in the home, angry family member (out of control) had been shouting etc (which I documented on the home notes), and next day I saw that someone had taken a black marker to cover over my handwriting. (So, I wrote a detailed addendum on a separate sheet which I provided for my office, in which I explained what had occurred)

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Criss, my experience has been that pt and families can read charts while the pt is in house only with the doc's permission or presence, to interpret. If the pt is no longer in house, it's done in medical records and the doc is not needed.

We allowed family (or others) to read the chart with the patient's consent. They were required to do so at the desk with a nurse present. We were not to answer any questions about any entries, but instead to refer them to the doctor.

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