DNR bracelet with DNR written on it. HIPAA??? - page 4

I was at a committee meeting today. We discussed color coded bracelets that our hospital is considering. One of them is a blue bracelet for DNR patients. It was mentioned that they also want to write... Read More

  1. by   kukukajoo
    I found this link with great information on the portable DNR card and it recommends jewlery as an option. It has some good information!

    http://www.nhchurches.org/index.php?option=com_docman&task=doc_download&gid= 21
  2. by   GregRN
    Quote from ncmc3132
    adding DNR to the bracelet would be a HIPPA violation---a color coded bracelet is all you need
    Are you sure?? Source? A blue bracelet, code for DNR, is protected information under HIPAA (not HIPPA...pet peeve) but putting DNR on that same bracelet is protected information? You might want to research that one...
  3. by   Kunzieo
    Quote from txspadequeen921
    this is a hipaa violation ..everything you have mentioned here is in violation of confidentiality. anyone can walk in these rooms and get information if they are just left hanging around. not to long ago anything that had the patients name on it had to come down at my job including the names outside the door, names on the outside of the charts and anything else that could identify a patient.

    no no no! it isn't! confidentiality and hipaa are two seperate issues. most of the hipaa act pertains to electronic transmission and storage of protected health information. it deals with how hospitals, md offices, pharmacies et al have to store the information with secure networks and computors, and how it is transmitted, via email, fax, etc.

    where the confusion comes in is that a bunch of corporate healthcare lawyers decided to take this way too far...and make all kinds of silly rules for the healthcare institutions that they work for...in case a patient ever decides to sue because his/her privacy was violated. that's were rules like "you can't give information about a patient over the phone" and "you can't have a patient's name on a door or a board at the station" and "you must stand behind this sign" at pharmacies and healthcare facilities came from.
    it is all a result of this sue-happy society we live in.

    while personal privacy must be protected in patients (during bathing, toileting, etc.), the effort to wipe out any evidence that a patient is even in the hospital is ridiculous. why don't we just use numbers instead of names? then we won't ever have to worry about anyone's privacy being "violated.
  4. by   Murse901
    Quote from Kunzieo
    This is NOT a HIPAA violation...(think of I/O sheets, lab-draw sheets, charge sheets, etc that hang in the room...legally, it's akin to that.)
    However, ethically...it's stupid to write DNR on the bracelet. I agree with the OP, the colored band is appropriate and sufficient.
    This may have already been address by someone else (I haven't read all the replies yet), but DNR is considered Protected Health Information because it relates to a healthcare decision that the patient has made and relates to the overall health status of the patient.

    The other things that you mentioned are not necessarily considered PHI (not to mention they are not usually hanging on any modern-day hospital wall). So, yes, it is a HIPAA violation.
    Last edit by Murse901 on Nov 30, '07
  5. by   RNperdiem
    Life was so much easier before HIPPA.
    Nurses used common sense about protecting privacy. Now HIPPA is just one more whip to beat us with and make our jobs harder.
    What is so bad about writing DNR? Is is it such a stigma to plan to die only once?
    The human mortality rate remains unchanged at 100% DNR status or not.
  6. by   rita359
    Quote from jlsRN
    I'm not sure if I was clear in my post. I'm not against the bracelet, but I think putting DNR on the bracelet is going too far. If the employees of the hospital are not able to learn that blue means 'no code' then they are probably not qualified to start a code.

    Putting DNR on the bracelet is also broadcasting the patient's code status decision to visitors.
    We train lay people to do CPR. Some people have done CPR in emergency situations by having watched medical shows were CPR was performed and been successful. You can be "john q public" and be qualified to start a code.I do not think putting DNR on the bracelet is broadcasting the code status. It is making certain the person finding the patient lifeless can be certain a code should not be done. That, after all, is the patients wishes.
  7. by   Murse901
    Quote from Kunzieo
    NO NO NO! It isn't! Confidentiality and HIPAA are two seperate issues. Most of the HIPAA act pertains to electronic transmission and storage of protected health information. It deals with how hospitals, md offices, pharmacies et al have to store the information with secure networks and computors, and how it is transmitted, via email, fax, etc.
    Just read this response today, and decided to do a little research just to make sure I wasn't being stupid about HIPAA. HIPAA originally only related to electronic storage and transmission of medical records, but has since been amended to include much, much more. Perhaps you could contact your facility's Staff Development Coordinator for a HIPAA refresher. Check out this link from the University of Miami related to Protected Health Information -- http://privacy.med.miami.edu/glossar...ealth_info.htm

    HIPAA regulations define health information as "any information, whether oral or recorded in any form or medium" that

    * "is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse"; and

    * "relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual."
    The bold sections obviously apply to DNR orders, and writing DNR on a bracelet would be a HIPAA violation, because it is health information that is recorded in a publicly viewable location.
  8. by   elthia
    Speaking as a daughter, not as a nurse.

    When my father was in the hospital, and he was a DNR. If he had been off of his floor for tests and had gone into cardiorespiratory arrest, and someone had performed CPR on him, you better believe there would have been hell to pay.

    Stating that he would not have been intubated, or no meds were used, or he was not shocked, would not cut it. The very fact that someone would have performed chest compressions on him after my family went through the heartache and anticipatory grief of making him a DNR would be enough for me to sue everyone who touched him for assault and battery.

    We did not decide on a DNR status because my father was terminal. We as a family decided that with liver cancer, hepatomegaly, and mets to his ribcage and sternum, that my father would never survive chest compressions; and the family would not want to live with the image of what CPR would do to him. I am ACLS certified...I had nightmares about this...thankfully my father died peacefully at home on hospice.

    Now speaking as a nurse
    Temper these feelings with HIPAA. I think a lot of pt's who are DNR, would be a bit upset if you told them, well you would only be DNR on this floor. In XRAY you might have CPR until someone reviews your chart and finds the order. And there is always the chance a housekeeper might find you down and perform CPR, but they'll stop immediately when the nurse tells them to.

    I don't think that would fly. On my unit, we have a fast pt turnover, it's a 40 bed unit, and only the charge nurse gets the full pt report. If I'm not charge, and I find a pt lying on the floor that's not mine. I check ABC's, no pulse no respers, I look at the armband. If there is no blue band, I push the code blue button above the bed and start compressions till help arrives. I don't wait on the chart, because if the pt is a full code, waiting to check orders before compressions isn't helping get oxygen to the pt's brain.

    I think we have to use some common sense. Using a blue armband with DNR should be ok...afterall the pt has an armband with his/her MRN #, which is also protected information. It's not like we are posting it on the door. It's on the pt's arm.
    Last edit by elthia on Dec 6, '07
  9. by   elthia
    Then again, we can always go to the source.
    (emphasis mine)

    Are physicians and doctor's offices prohibited from mantaining patient medical charts at bedside or outside of exam rooms, or from engaging in other customary practices where the potential exists for patient information to be incidentally disclosed to others?
    No. The HIPAA Privacy Rule does not prohibit covered entities from engaging in common and important health care practices; nor does it specify the specific measures that must be applied to protect an individual’s privacy while engaging in these practices. Covered entities must implement reasonable safeguards to protect an individual’s privacy. In addition, covered entities must reasonably restrict how much information is used and disclosed, where appropriate, as well as who within the entity has access to protected health information. Covered entities must evaluate what measures make sense in their environment and tailor their practices and safeguards to their particular circumstances.

    For example, the Privacy Rule does not prohibit covered entities from engaging in the following practices, where reasonable precautions have been taken to protect an individual’s privacy:

    Maintaining patient charts at bedside or outside of exam rooms, displaying patient names on the outside of patient charts, or displaying patient care signs e.g., “high fall risk” or “diabetic diet”) at patient bedside or at the doors of hospital rooms.
  10. by   kukukajoo
    Maintaining patient charts at bedside or outside of exam rooms, displaying patient names on the outside of patient charts, or displaying patient care signs (e.g., “high fall risk” or “diabetic diet”) at patient bedside or at the doors of hospital rooms.

    Possible safeguards may include: reasonably limiting access to these areas, ensuring that the area is supervised, escorting non-employees in the area, or placing patient charts in their holders with identifying information facing the wall or otherwise covered, rather than having health information about the patient visible to anyone who walks by.

    The above examples of possible safeguards are not intended to be exclusive. Covered entities may engage in any practice that reasonably safeguards protected health information to limit incidental uses and disclosures.
  11. by   firstaiddave908
    Thats a great idea to have a color coded band that states a pt is a DNR. the points that are made on this posting is great.
  12. by   tddowney
    Quote from MNmom3boys
    I know privacy is important, but if they have made the effort to make a decision and declare a DNR status it needs to be clearly marked somewhere what their wishes are. (Charts are not always accessible and/or w/ patient.)

    Exactly. The Pt's choice has to be communicated to those that could follow/not follow it.

    In the magic world inhabited by lawyers and commissions, every caregiver can remember the code status of Pts with perfect accuracy, along with their fall risk, allergies, which arm has a new, immature AV fistula, etc.

    For a nurse on the floor, with 5 Pts that change every shift, such a world is laughable.
  13. by   RNperdiem
    The whole job of that colored armband is to communicate. You should be able to randomly show that band to any employee and ask "what does this mean?"
    If there is any confusion, and there often is everytime a new protocol rolls around with it's different colored armbands, symbols, then is fails as a communication tool.
    I think I'll just have DNR tatooed on my chest when that time comes.