HIPAA/confidentiality during an Outbreak

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  1. Is it legal/ethical to tell the patient the actions are to prevent Scabies?

    • 12
      Yes
    • 2
      No

14 members have participated

I am a nursing student working on my bachelors and I work as a CNA on a subacute rehab unit. We have had a recent breakout of Scabies in a couple patients. We are acting prophylacticly and treating every patient on the unit with a shower and 1 topical treatment of cream followed by a second shower the next day.

I told one of the patients that I needed to take her for a shower and then apply a cream to her body. When she asked why, I told her there was a breakout of a rash in the facility. She asked what the rash is, and I proceeded to tell her Scabies. Immediately, 4 nurses jumped in and told me to not say anything more and that I cannot tell her what the outbreak is. Later, one of the nurses said I shouldn't talk to the patients about the showers. The way they reacted made me feel pretty incompetent and down about myself.

Did I really do something wrong? Or am I allowed to tell the patient the name of the disease? In my head, the patient is being told they have to do something for a medical reason and then put a prescription medication all over their body. To me this sounds las though it is unethical to refuse to tell the patient what the prescription is for. In no way did I tell the patient who had confirmed scabies. Was I in the wrong for telling the patient? Should I have refused to tell her it's for scabies?

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Specializes in Complex pedi to LTC/SA & now a manager.

It is not within the scope of a CNA to reveal such information. The patient's physician or nursing management should handle the notification. When the patient started asking questions which technically are clinical in nature you should have deferred to the nurse. It is not your job to disseminate clinical/diagnostic information. This is not a HIPAA issue but a clinical scope of practice issue. Care is taken when releasing sensitive information and rfe nurses likely received instruction just like they received the orders to bathe all patients.

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Agree with the above, although I will add that if they are saying no one is allowed to tell the patients what the outbreak is because it would be a HIPAA violation, they are certainly WRONG about that, and your line of thinking is correct - although the CNAs shouldn't be the ones discussing it with patients.

What would be a HIPAA violation with regard to this matter, is telling others which patient was diagnosed with scabies.

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If the patient is having a medicated cream applied to her body then she has every right to know what it is and why it's being used. The CNA should not have been put in the position of doing the treatment without a nurse FIRST explaining the situation to her. This is on the nurses not the CNA who basically got thrown under the bus.

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Specializes in Psych, Addictions, SOL (Student of Life).

Please clarify your details - the way I read this you were treating a patient who did not have a rash/scabies and that resident what she was being treated for. Scabies in the SNF and group home setting is reportable to the State department of health under Title XXII of the Healthcare Institutions Code which says that infestation be reported. Such a report opens the facility to additional over site by the governing agency. It may be that the facility is not talking about it because the facility fears being reported.

I had a similar experience when I worked in a group home as the nurse consultant notified the owner that there was a case of scabies. His response was "Treat the patient then wave you magic wand and make it go away."

The reason I asked about the current condition of the patient is that there is no evidence that prophylactic treatment of asymptomatic patient's stops the spread of scabies. The fact that the nurse did not inform the patient that he/she had scabies is concerning.

Hppy

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If the patient is having a medicated cream applied to her body then she has every right to know what it is and why it's being used. The CNA should not have been put in the position of doing the treatment without a nurse FIRST explaining the situation to her. This is on the nurses not the CNA who basically got thrown under the bus.

Absolutely.

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To clarify, this patient does not have confirmed scabies, only 2 out of the 45 patients do. However, the entire unit has been prescribed the topical treatment.

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Thank you for your answer. I feel as though I've been put in an awkward position because every patient needed the shower and cream and none of the nurses pre-explained anything to the patients. When the medication finally arrived from the pharmacy, it was already 2130. The nurses didn't want to be bothered this late in the shift. When I told them patients are asking why they need the treatment, they rolled their eyes and scoffed. All of this made me feel insecure of myself as a future nurse.

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When I told them patients are asking why they need the treatment, they rolled their eyes and scoffed. All of this made me feel insecure of myself as a future nurse.

Why? You properly assessed the situation and identified that a patient has a right to know what they are being treated for and how. The nurses were wrong in how they handled the situation. How does that reflect on your future as a nurse?

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When I told them patients are asking why they need the treatment, they rolled their eyes and scoffed. All of this made me feel insecure of myself as a future nurse.

You know, that is kind of a repeating theme on this forum and I'm not sure why. Commonsense and ethics let you know that the way this situation is being handled isn't right. The eye-rolling and scoffing are your confirmation that these individuals aren't behaving professionally/ethically.

Learn now not to let others whom you know are wrong make you feel *anything* about yourself. They have literally nothing...zero...to do with you. The faster you believe this, the better off you'll be.

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Specializes in Psych, Addictions, SOL (Student of Life).
To clarify, this patient does not have confirmed scabies, only 2 out of the 45 patients do. However, the entire unit has been prescribed the topical treatment.

Well that's over kill! I bet the facility charged Medicare a bundle to do that!

Hppy

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From a federal legal standpoint;

Nothing about this situation was HIPAA privacy issue. As Someone already mentioned, without disclosing whom has/had scabies there isn't a privacy violation.

Second, federal law, as well as most state patient rights law, mandates that each patient has the right to know their diagnosis and options for treatment. In most cases, patients also have the right to object to treatment.

As a CNA, you most definitely should not have been forced into this position, but your actions, though probably not part of your job description, probably saved your employer from violating the law. I would speak to management about making sure patients are being properly consulted about their medical needs.

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