HIPAA and "Hallway Patients"

[HomeBound]

Nurses are being bombarded left and right with rules and regulations that, if broken, can mean the end of a career and perhaps potential financial ruin.

My questions are simple, as the trends are seemingly "from the top down", and blame/responsibility lands squarely on the nurses.

What about hallway beds? I've worked at three facilities so far that "hall" patients for their entire stay. No curtains, no privacy. I am required to care for them, discuss their care/diagnosis/prognosis/aftercare/appointments at discharge--in full view and hearing of every single other patient in that hallway. I'm required to (at times) perform embarrassing procedures like foley placement, by pulling a flimsy "screen" around their bed, because no rooms are available. I'm required to perform the 5 Rights, stating their name/DOB with other patients and their families in full view.

Where is the hospital's responsibility for the "sacred" keeping of patient information?

I've had patients and their families eavesdrop on my conversations with other patients---and comment to me...."Isn't that awful? That poor man. He's got cancer! What will you do for him?" I've even had a patient defend me against another patient who was threatening to turn me into the board for enforcing a doc's order to cut her off from her dilaudid. He volunteered to go to my RN Mgr on my behalf!

The onus should not be solely on the nurses. The hospitals are placing us in this ambiguous "Do as I say, not as I do" position. If the hospital isn't responsible for affording patients privacy even at the lowest level (on a gurney in the ER), then how it is that nurses can be prosecuted for HIPAA violations that the hospital actually creates?

What are your stories of privacy issues that were created by the environment in which you work--and what is your unit's policy on these issues?

[guest1048932]

It is my understanding, and perhaps that understanding is wrong, that whenever possible, we are to give patients the most privacy we can under the circumstances. Unfortunately, that sometimes means the difference between preserving privacy and providing necessary care. I would love for my patients to all have private rooms, but the reality of hall patients is all too real. In those cases, you do the best you can. In my facility (extended care, private facility), when I have something to discuss privately with someone and they don't have a private room, I either empty the room so we have privacy, or I take advantage of procedure rooms or examination rooms when I can. Otherwise, I pull a curtain and make do with what I have. I try my hardest, but sometimes, the setting simply does not allow for complete privacy. I feel for my patients though. They deserve better than a curtain that doesn't muffle voices or mask smells.

Obvious breach of privacy: During my clinical hospital rotation, I had two elderly male patients sharing a room. Mr. A was near blind and VERY hard of hearing but refused to wear hearing aids. Mr. B heard and saw perfectly fine. Normally, with hard of hearing patients we would write on a communication board to communicate clearly. Well, not for Mr. A who is nearly blind! The doctor had to explain to Mr. A that he needed a catheter because he had BPH and wasn't able to urinate. The exchange went something like this:

Doctor: Mr. A, we need to put in a Foley catheter. Your prostate is large and that's why you're having trouble peeing.

Mr. A (yelling): WHAT?

Doctor (yelling): A CATHETER. IT'S A TUBE THAT GOES UP YOUR...

Mr. A (yelling): A WHAT? WHAT DID YOU SAY?

Mr. B (yelling from the next bed over): HE SAYS HE HAS TO PUT A HOSE UP YOUR D***!!

Mr. A (yelling): A D*** HOSE?

Doctor (yelling): YES MR. A! IT'S GOING TO EMPTY YOUR BLADDER!

Mr. A (yelling): WHAT?

Mr.B (yelling): IT'S GONNA HELP YA PEE!

Guess which lucky nursing student learned how to catheterize a patient with BPH using a Coudé Foley that day? Me, JollyBug!

[antsrt4, BSN]

priceless to be there to hear that....enjoy

[JKL33]

The "incidental disclosures" thing arguably may cover some of this - otherwise a thousand and one more things would have to change, which, maybe they eventually will but right now no one big is pressing the issue.

Even with incidental disclosures, though, they are to be minimized whenever possible. Use the partitions, speak with the lowest volume that can be heard by the patient, do everything humanly possible to maintain their bodily privacy, consider moving them to a more appropriate area whenever possible, especially for sensitive convos or sensitive care. I routinely move patients for exactly these reasons. It's one thing to have a run-of-the-mill sprained ankle or sore throat in the hall, but it gets dicey as soon as you get much more involved than that.

Even more than HIPAA, my motivation for moving people comes from trying to respect/maintain their comfort, dignity, and sense of privacy.

If you don't even have enough partitions/screens or something like that, I would raise the concern.

I think overall the issue is one that doesn't get pressed much because no one has a perfect solution to the overcrowded ED.

[ruby_jane, BSN, RN]

On 2/19/2019 at 8:05 PM, JKL33 said:

Even more than HIPAA, my motivation for moving people comes from trying to respect/maintain their comfort, dignity, and sense of privacy.

YASSS! The choir says Amen, JKL.

[yaRNthrower, BSN, RN]

Jolly Bug,

I have tears in my eyes. Thank you. I needed that.

[Jory, MSN, APRN, CNM]

HIPAA...is not difficult. I have never seen a case where a nurse had their license sanctioned on anything but an action that was purposeful...posting something on social media, pulling up a chart they shouldn't have on someone they knew, etc.

HIPAA protects what I call incidental eavesdropping. A more common case is smaller hospitals where there are semi-private rooms. You try to work around it as much as possible (write things on a board if they can read that are very personal) ask as many yes/no questions as you can...but that is all you can do.

When a hospital is overwhelmed there is no way privacy can be 100% guaranteed. Unfortunately, that is the way it is.

Nobody gets in trouble over that.