Hipaa violation?

MN-Nurse, ASN, RN · Dec 28, 2012

Recently I had a patient who had a 24hour caregiver and passed away. Right after, a new patient went in their room... They had a history of falls. Over the holiday a caregiver came in for their room and I said "for this room ?are you sure?" She said "yes this is the room the agency told me to go to.." I Stated the patients name and she said "yes that is the right patient."
Once 5am rolls by the caregiver went on her computer and noticed the patients name she was assigned to didn't match the room number... In fact, the patient she was assigned to was different gender. So she came up to me stated she must be at the wrong facility and I said "who were you supposed to be for ?" And she stated the name and it was the patient that was previously in this room and that patient had passed away. she was covering for a caregiver over the holidays and the agency never informed her that the patient had passed. She took care of this patient for 10 hours before she realized it was the wrong patient.
I charted all of this and even let the family know and they stated, "wow you got lucky! It must've been an easy night."
But now I'm worrying , hipaa violation? Or am I making this more of a big deal than it is?

This is one story I would not go around repeating. The only thing that could have saved you was to ask the PCA to state the patient's name.

Unfortunate incident, but lesson learned.

Marshall1 · Dec 28, 2012

If you have a Risk Manager or someone similar where you work that handles HIPPA I'd ask them. I would've filled out an incident report and notifed the supervisor for sure.

Kunzieo · Dec 28, 2012

I'm wondering more about the billing problems created rather than HIPAA?

Mr 1st Patient is no longer alive, and he/his insurance can no longer be billed, yet the agency sent a sitter who worked 10 hours.

The agency can't bill Mr 1st Patient.

They can't really bill Mrs 2nd Patient because she didn't have a sitter ordered?

The sitter still needs to be paid for her 10 hours. (even though it sounds like she is responsible for most of this mixup...)

Good luck.

nurseprnRN, BSN, RN · Dec 28, 2012

Definitely tell the facility risk manager. It's nice that the family is being good about it now, but that could change. And yes, it would be a HIPAA violation, and be on your facility because it didn't check the sitter's assignment before they allowed the sitter access to the patient's PHI (private health information). Was the sitter as dumb as a box of bricks? Yep. Should the agency that sent her have been damn sure she knew the patient name and gender before sending her? Yep. But you are the ones who let her take care of that patient without knowing for sure that it was a correct assignment.

I agree with MN-Nurse-- I would keep this close to your chest and let your risk manager handle it from here.

strawberryfields · Dec 29, 2012

I was worried about billing as well, it would've been holiday pay as well. I couldn't believe she was completely sure about them being her patient when it wasn't even the right gender! I documented everything and even documented that I notified the supervisor but no one informed me to fill out an incident report ... No one made a big deal about it but I'm afraid this is going to haunt me later? The patient goes home this week...

strawberryfields · Dec 29, 2012

oh and can I file a late incident report on this?

eatmysoxRN, ASN, RN · Dec 29, 2012

I think it may be time for a policy to outline proper caregiver check in. It is a risk to the patient (what if a caregiver was just in the wrong room and the patient they were supposed to be with was in the facility but in a different room?) I'm sure this happens more frequently than it should in nursing. Perhaps suggest implementation of a new policy to prevent this.

Did the caregiver access the patient's chart?

strawberryfields · Dec 29, 2012

No access to the patients chart, all of the patients have their names outside their doors so before even going in I pointed to his name and said is this the right patient ? And she said yes. So no further information was given. And I agree this needs to be addressed because no one knows what to do... This patient goes home before I go back to work but now I'm scared I should do an incident report so this won't haunt me later...

Meriwhen, ASN, BSN, MSN, RN · Dec 29, 2012

oh and can I file a late incident report on this?

AFAIK, it is never too late to file an incident report, but every facility's P&P can vary. As GrnTea said, talk to your facility risk manager first and let them take it from there.

psu_213, BSN, RN · Dec 29, 2012

This is a good example (especially since no serious harm was done) of why room number is never a valid patient indentifier.

I agree that there needs to be a set procedure established for checkin for 3rd party caregivers. For example: they check in the front desk for a visitor's badge and they are directed to the correct nurses station. They talk with the nurse (not a rec aide, not someone from dietary, not a CNA--the licensed nurse on that unit). The caregiver states "I am Susan Smith, a caregiver from XYZ agency. I am here for resident Agnes Andrews, birthday June 3, 1921." The caregiver shows proper identification. The nurse walks the caregiver to the correct room.