HIPAA and ROI policies

Balder_LPN, LPN · May 28, 2008

Hello all! I work at a large (1000+ beds) hospital, and I need your advice. I'm tired of trying to figure out who I can talk to and what I can tell them when they call on the phone to check on pts. It also seems like different people give different info, so family members get frustrated. They call one day and someone tells them everything, and the next day all they get is "sorry, I can't give any info over the phone." I was thinking of proposing some sort of passcode system. For example, on admission, a patient would be assigned a number or password, and info could only be given out to people with said number or word. It could be on the face sheets or the front of the chart, or for electronic records, somewhere within the main info page. It could even be the pts admission number (at my facility it's a 10 digit number that is all over EVERYTHING, so that would be really easy for us to verify and not so easy to fall into the wrong hands). My question is, does anyone currently use a system like this, or have and feedback about such a system? I really appreciate any feedback anyone can give, or details about any kind of policy/system you might use. Thanks!!!

I havent seen a system like this. I think I know a bit about HIPAA but I am not sure off hand how this would meet the requirements. Check thier website and see if you can find anything about using a passcode system. It may have been addressed and perhaps provide some guidelines.

A facility this large should have some kind of confedentiality officer and probably a commitee too. Sounds like you should look for these people and join in if you can.

RN1982 · May 28, 2008

At the hospital where I work, we use a passcode. Its given to the family spokesperson and only the family spokesperson. Then the family is given a code and password and a phone number to call where they get a recorded message of the patient's status. It works ok. I haven't had any problems yet. At my other job, for one patient I will get 6 phone calls from family after awhile its rather annoying and I end up telling them that they need to start relaying messages to the other members of the family.

miko014 · May 29, 2008

At the hospital where I work, we use a passcode. Its given to the family spokesperson and only the family spokesperson. Then the family is given a code and password and a phone number to call where they get a recorded message of the patient's status. It works ok. I haven't had any problems yet. At my other job, for one patient I will get 6 phone calls from family after awhile its rather annoying and I end up telling them that they need to start relaying messages to the other members of the family.

Yeah that's a big part of the problem too...first Dtr calls, then son, then aunt, then nephew, then cousin Ed, all about the same pt! I love the idea of a designated info person, but even if that is policy, you'll still have to field the phone calls. Instead of "I can't give out much information over the phone, because I have no way to verify who I am speaking with...", you'd just be saying, "I'm sorry, but updates are given to Sally Sue Dunebuggy, because she is listed as the next of kin. If you'd like details, you will have to call her."

That recorded message thing seems complicated, but is an intriguing idea. What I'm thinking of is more like just the person calls and says "Hi I am Mary Beth Busybody, John Callbutton's daughter. Can I speak to his nurse?" then you get on the phone and the first thing you say is "can I have the passcode please?" and if she can't tell you "0987654321" or whatever his is, then you just say you can't give out info without the code. What I hate even more than phone calls is when someone shows up at the station and starts asking questions...then it's really hard to know what to do. If the pt is A&O, I usually just go ask them if it's okay for me to talk to So-and-so, but if they're not, most people just assume it's okay to give the info. I hate that, I wish there was some kind of clear cut rules and that's that. WAAAAAAYYYYY too large of a gray area in my opinion! Thanks!

paticake · May 29, 2008

Where I work, we tell the patient that anyone they would like to receive information about their health status must give us a code. The code is the last four digits of the patient's ss#. This helps us find the number quickly and easily for verification. Hope this helps.

TazziRN, RN · May 29, 2008

Our local hospital has a numerical code that each inpt is assigned, it's printed on their name bands. Callers have to give that number before staff will talk to them, no ifs ands or buts.

What we did in the ER where I worked: when someone called and we were unable to ask the pt what we were allowed to say because they were in x-ray or wherever, we would only say "Yes, John is a pt here and we're working him up. I cannot tell you why he's here or anything else."

When the relative left and said they would call back later for info, I would verify the identity on the phone by asking the pt's birthday or middle initial.

miko014 · May 29, 2008

Our local hospital has a numerical code that each inpt is assigned, it's printed on their name bands. Callers have to give that number before staff will talk to them, no ifs ands or buts.
What we did in the ER where I worked: when someone called and we were unable to ask the pt what we were allowed to say because they were in x-ray or wherever, we would only say "Yes, John is a pt here and we're working him up. I cannot tell you why he's here or anything else."
When the relative left and said they would call back later for info, I would verify the identity on the phone by asking the pt's birthday or middle initial.

But what about the situations where the pt does not want so-and-so to know anything, or the POA doesn't want this brother to be allowed to visit, etc? Those people probably do know the birthday and MI. I like the bracelet number though - the family could just write it down before they leave, and if you cant recite that to me, you get no info.

paticake · May 29, 2008

The medical number from the patient's bracelet is a good idea, but a person could get that information from the patient while visiting and use it later. Using the last four of the patient's ss# is also good, because the patient would only give the pass code (the person wouldn't have to know that it's the patient's last four digits, the patient can just say, the pass code for information is ####, and leave it at that). This gives the patient control over who gets information, and who doesn't.

mom2michael, MSN, RN, NP · May 29, 2008

When I was a US in the NICU the family had pass-codes in which they set up on their own and had to be done on the day of admission. Parents could call at anytime, other family could call about the baby during specific hours and regardless a pass-code had to be used and said each and every time anyone called. They were not to even make it past the US to the RN w/o a pass-code.

If a turn of events occurred and a person got a pass-code and they weren't to have it - it was changed by the parent(s).

We had these babies for weeks, if not months but we had to be diligent in using the pass-code system for the baby's sake. Parents would get frustrated and believe me, Aunt Sally from 2000 miles away would come unglued if she called outside the specific time frame and/or didn't have the pass-code.

The ICU at the facility where I work now uses a family spokesperson and it's probably the greatest thing ever for the staff there. However, I am the family spokesperson currently for a sick family member and it makes me somewhat crazy because EVERYONE calls me, but that's OK, it saves them from calling and keeping the ICU nurses busy with a million questions, so I'm good with that.

The ER where I work, we rarely give out much info. We just say....yes they are here and we are currently in the process of treating them. If they insist on talking to the patient and/or family - we get out the cordless phone.

catlynLPN · May 29, 2008

Where I work, which is akin to a LTC, the people we can give information to, BESIDES the guardian, their names are blocked in a PINK color on the face sheet. If the guardian, or in your case, the patient, has given the okay for other people to have information then their names will be inside a pink block of color.

Very easy to deal with.

miko014 · May 29, 2008

Where I work, which is akin to a LTC, the people we can give information to, BESIDES the guardian, their names are blocked in a PINK color on the face sheet. If the guardian, or in your case, the patient, has given the okay for other people to have information then their names will be inside a pink block of color.
Very easy to deal with.

How do you verify that the person you are talking to really is the person with the pink-blocked name? I mean, I could call you and say that "I am Sally Johnson and I'm calling to see how my third cousin twice removed is doing". That could really even happen in person, if someone walks up and asks for info about the pt in room 123 and says his name is Mr. Pibb, and accroding to the inifo sheet it's ok to give him info...what if they just say they are the person with the ok? Not to pick on you but that's a problem we have run into - someone called and said they were the pts son, who the nurse knew, and gave the info, then a few minutes later, the real son called...oops!!!!!