HIPAA violation?

[sunnyskies9]

I received a text from a family member that my husband's aunt had been admitted to the hospital where I work. It just so happens that my department received an order for an inpatient consult. So I got in her chart and went and saw her in her room like I do with all of my other patients. Do any of you know what can and cannot be discussed with family without violating HIPAA? This seems like such a gray area between my family's family member and a patient of mine. Thanks!

[kakamegamama]

First, was she your patient? From reading your statement, it seems that she was?

Let her be the one to decide what you can and cannot discuss with other family members. I would think that if Aunt Susie isn't on her HIPAA approved list of those who can receive info about her situation/care, then Aunt Susie cannot hear info about your husband's aunt.

I certainly wouldn't try to be the "bearer of news" in this situation, unless your husband's aunt appoints you as such. That can be a sticky wicket.

[RotorRunner]

Why were you looking in her chart? Unless you were the nurse in direct care of the patient you never should have opened it. Personally, if I had a family member admitted to a floor I worked on I would stay far, far away from it.

You cannot discuss any aspect of her care with anyone in your family unless you have her express permission.

[sunnyskies9]

We were consulted by her cardiologist to start her in our program. She is not technically a family member, either.

[klone, MSN, RN]

Tell them nothing

[kakamegamama]

Your husband's aunt isn't a family member? Hmmm.....

Anyway, as the previous poster stated, unless you are caring for her, you should not be in her chart. And, do not discuss her situation with anyone, unless she gives you permission. You can get yourself into a lot of trouble doing that.

[KelRN215, BSN, RN]

How is it a gray area? Any information you have you gained from your professional relationship with her during her hospitalization. You cannot tell them anything.

[MunoRN, RN]

I would ask the patient and if they approve then it's not a HIPAA violation to share information with the family.

In your particular role, which appears to be cardiac rehab, family is often involved in the care of the patient after discharge, in which case you don't actually need specific permission but rather just need to provide the patient with opportunity to decline the sharing of information with family that they may need to effectively help with the patient. If they want specific information that isn't related to post-discharge care then the patient is free to give you permission to share that information under HIPAA.

[JKL33]

Don't over-complicate this. HIPAA is applied here the same as it is for any other patient.

[sunnyskies9]

I'm going to clarify a few things. MunoRN seems to understand. My inpatient role is strictly education on their diagnosis, treatment, activity restrictions and our program. It does not involve direct patient care. Direct patient care starts when they are enrolled in the outpatient setting. She has told all of her family the admitting diagnosis and intervention. But given the knowledge that I have about her diagnosis and the severity, what further education can I give/not give to my family without crossing professional or personal boundaries? I appreciate the responses thus far.

[KelRN215, BSN, RN]

I'm going to clarify a few things. MunoRN seems to understand. My inpatient role is strictly education on their diagnosis, treatment, activity restrictions and our program. It does not involve direct patient care. Direct patient care starts when they are enrolled in the outpatient setting. She has told all of her family the admitting diagnosis and intervention. But given the knowledge that I have about her diagnosis and the severity, what further education can I give/not give to my family without crossing professional or personal boundaries? I appreciate the responses thus far.

Ok, if Auntie told the family "I have been diagnosed with ALS" (or whatever the disease may be) and the family knows that you work in an ALS program, I would say you can answer their questions on a very general level. Don't include anything you specifically know about Auntie but you can tell them generally about the disease and its expected prognosis. HIPAA still applies even if you aren't doing direct patient care. If Auntie later tells everyone "sunnyskies9 works in the program I'm being treated at" that could open a can of worms for you with relatives asking you questions specifically about her care.

Personally, I would prefer not to have these conversations with a family member if some distant relative was diagnosed with something I have intimate knowledge of. I remember saying to one of my pedi neuro nurse friends, for example, when my best friend's daughter was born at 23 weeks and had bilateral IVHs "let's be honest, this kid is at least going to have CP and Epilepsy" (and she does) but I wasn't going to be the one to tell my best friend that. And when the child was later diagnosed with these things, I didn't say anything about how I figured that would be the outcome.

[JKL33]

sunnyskies,

How would you handle educating a family when you aren't sure what they know (or what the patient wants them to know) about the patient's condition, severity, or overall prognosis?

Have a private discussion with the patient first, and share information in a way that it is in line with his/her wishes regarding what they want their family to know. You can probably actually have this current discussion with her. "Aunt Susie, what would be appropriate for me to share about your condition if family members ask me questions as a nurse who has been involved in your hospital visit?" "Do you want them to know ______?" "How about _______?" "Do they already know ______?" "I will not share any information you don't want me to, and if they ask questions I'm not sure how you would want answered, I am going to refer them to you."

Have a pleasant stock response at the ready in case you are asked probing questions and don't know how the patient would feel about you answering the question: "You know, we didn't discuss this so I will refer you to her - she may wish to bring it up at her next follow-up visit." If pressured/pressed: "I really can't say; I don't have that answer." Don't be coy/suggestive with your tone/body language, either. Just professional and matter of fact.