Shift report and HIPPA

[GiGiRNICU]

I work PRN in a hospital and I also take nursing students to the same hospital. My question is as the semester was ending, the hospital changed the policy on shift report...it is done at the bedside, in front of family/friends and even done if front of other patients (semi-private rooms). When I questioned the staff as did the staff to the managers and DON we were all told it was not a violation of HIPPA. Was told if there was something you didn't want your patient (family member) to hear, then you are to finish the report in the hall outside the door. Once again another HIPPA violation. Some of the nurses are refusing to give and receive report in patients room and are being told they had better!!!! I think someone higher up outside the hospital needs to notified of HIPPA violation and nurses being forced to do so. What happened was some big CEO from another hospital came in made rounds and made the suggestion that report should be at bedside and since he said it they think that is how it should be done and it is not a HIPPA violation.

[organichombre, ADN, BSN, MSN, LPN, RN]

I cannot imagine who that fool was and what regulations they are choosing to violate! Find another place to work would be my suggestion or send JCAHO an e-mail.

[catshowlady]

They started this crap at my hospital too. Supposedly, it's not a HIPAA violation, because the roommate knows everything about their roommate's care anyway. :icon_roll I don't agree, but the nursing staff was overriden, and told we would be written up if we didn't do "walking rounds".

It's all about "customer service" and PG's. The patients seem to like it. Earns better scores on the "keeping you informed" question.

I hate it, because report takes twice as long, in addition to being inappropriate. I hate having to stop and answer pt questions. I love to explain and educate normally, but not in the middle of report!

[jaccimv]

At my hospital we do bedside report. I am totally not a fan because of hippa, however, there are plus sides. When appropriate to do this at the bedside..it allows me to check iv sites, etc. making sure things are finished so to speak?? we all know what its like to follow someone and go to the pt and find this and that. it allows the nurse to be held responsible.

the number one thing that my hospital goes on is how this helps with pt satisfaction. and when we bring up hippa they say well look at the docs... the other pts hear all day what is going on with their roomie by the rn, doc, family members, etc.

i do it because if we dont we get written up. go figure. but im able to see the plus and minus of it.

[jjjoy, LPN]

HIPAA allows for the verbal exchange of patient information in areas where it may be overheard in the normal course of provider intercommunication as long as "reasonable" measures are taken to keep communication as private as possible. That means that if a roommate overhears PHI(eg date of birth, year of appendectomy, patient's current issues with incision pain, etc) spoken in a normal voice, that's not a violation of HIPPA. Judgement is involved, though. If there is particularly sensitive PHI, the provider should take extra care in their communications.

For bedside report, I would hope that nurses would ask the patient if they'd like the family to step outside during report. But I don't know that it would be a violation of HIPAA if they did overhear report given in the patient's room. Ultimately, the patient does have the right to ask any visitor to leave at anytime. Certainly, there are interpersonal dynamics involved that can make that difficult, but it seems going a bit too far to have it essentially be ILLEGAL to talk about a patient's condition in the patient's hospital room! On the other hand, if a care provider is using their electronic access to snoop into acquaintances' or celebrities' medical records then that's certainly a violation of HIPAA.

Keeping patient information private has always been a priority. No one has even been allowed to take home copies of patient records or to openly identify and discuss patients outside of a work setting. The main impetus for HIPAA was to clearly delineate electronic medical records as PHI and thus subject to the same kind of privacy protection as hard copy medical records. Even if you have access to all kinds of electronic PHI, you shouldn't access it unless you personally are involved in that care. And if PHI is accidentally faxed or emailed to your office, you should destroy it, not use it.

It seems that many managers and administrations have gone overboard in interpreting HIPAA to meant that not one shred of PHI ever be overseen or overheard EVER! But that becomes a hindrance to providing timely, efficient care to patients, which HIPAA isn't supposed to do.

Well, that's my understanding of it, anyway!

[Mulan]

I thought this was a new thing from JCAHO. JCAHO is the one who wants to see this, is my understanding. What I want to know is why isn't it a HIPAA violation or a privacy/confidentiality violation for those JCAHO people to be listening in to report? If I were a patient I would refuse to allow them to listen.

[ErraticThinker]

I wonder what that CEO's background was. it always cracks me up when non medical types try to determine best practices at the bed side. I would argue that it could be a violation since granted the roommate probably hears this and that, but they shouldn't hear the gritty details that are discussed in rounds or report, and i doubt most patients would want total strangers knowing that.

bedside report needs to be filed under "it seemed like a good idea at the time" because in practice it never works out. patients interrupt, they get mad when what the nurse says doesnt exactly match what the physicians say (like time of discharge), and ultimately, I don't feel like censoring myself when i report off. If the patients a pain, and needy and needs to have firm limits set, then I want to be able to say it. I'm all for both nurses going bedside and looking at IV's, dressings and all that so that they're both on the same page, but that should be a quick thing after the nurse has already gotten the history and everything else.

[racing-mom4, BSN, RN]

Our unit just recently started closing down the entire unit to visitors during the 6:45-7:15 time frame. We give report at the nursing desk but were sick of family deciding 6:55 was the time to ask for a warm blanket and lean over our counter.

I would NeVER give a verabal report in a pt room---think about it, sometimes we say things that the pt may not like to hear but yet it is valualbe info. "She gets crazy on morphine" "she has asked to use the bsc 101x and it takes her 20min to get there but only goes 30cc." "get help rolling her or you will kill your back"

[wooh, BSN, RN]

Our unit just recently started closing down the entire unit to visitors during the 6:45-7:15 time frame. We give report at the nursing desk but were sick of family deciding 6:55 was the time to ask for a warm blanket and lean over our counter.

I would NeVER give a verabal report in a pt room---think about it, sometimes we say things that the pt may not like to hear but yet it is valualbe info. "She gets crazy on morphine" "she has asked to use the bsc 101x and it takes her 20min to get there but only goes 30cc." "get help rolling her or you will kill your back"

Wouldn't it be nice if we were to all band together and actually give a "real" report at the bedsides. Give that valuable info that the next nurse needs. When customer service scores plummet, it will be abandoned in a heartbeat. Heck, mention in the room about their STDs and everything they're positive for and everything they're pending drug levels and such. It will be fabulous to increase our communication scores on Press Gainey!

[DoeRN]

We do this too. It has its pros and cons. I always ask family members to step out of the room especially in a semi-private. Some get huffy but they still leave.

Pros- You can see what was done and what wasn't and make sure things are done before the next shift leaves.

Cons-You can't say this pt broke my back last night, is real needy, drove me crazy, etc. Even though we go in about a half hour before to get the pts ready for report they will still ask for stuff like going to the bathroom, repositioned, asking a whole bunch of questions, pain meds (even though I just asked them 30 min ago when the pain medicine was due). We can give a small report outside the room but this is discouraged. I think by not being able to give a private report things will get missed. I could go on and on with the cons. I guess our satisfaction scores will go up now but staff moral will go down.

[Batman24]

We don't do bedside report...thankfully. I believe they did it for about a week before I was hired and it went to the wayside due to O/T. It was costing a lot more per shift as it was taking triple the time to do reports due to interruptions, waiting for family and friends to leave the room, etc.

[Tippy-ta-ta]

you would think it would be a violation of HIPPA.