HIPAA Violation?

[kankuro]

Is it a HIPAA violation to endorse narcotic medications by reading it aloud and completely (name of patient, medication & dose, and number of pills) even when patients are around? This is in a LTC setting. Is there a specific policy/law with regards to this?

[EricJRN, MSN, RN]

Assuming that you're trying to be reasonably discreet, I think this might fall under the umbrella of an incidental disclosure. Here's a web link with more information on incidental disclosures.

HIPAA - Incidental Disclosures of PHI

[kankuro]

What if the practice is strongly encouraged by the immediate supervisor or director?

[Esme12, ASN, BSN, RN]

Did you use the link that Eric provided?

General privacy principles founded in state law and the HIPAA Privacy Rules are not intended to prohibit the treatment team from talking to each other and/or to their patients. Of course, others outside the treatment team may be in the general area during these discussions and may overhear information that they do not need to know. While reasonable precautions should be used to avoid sharing patient information with those not involved in the patient's care, it is possible that minor amounts of patient information may be disclosed to people near where patient care is delivered or being coordinated. This is referred to as an incidental disclosure.

Privacy principles do not prohibit an incidental disclosure of patient information so long as reasonable safeguards are taken to minimize the disclosure

What is the location you are doing this? What are you doing? This may be one of those unavoidable things.

[nurseprnRN, BSN, RN]

You know, when somebody giveth a good link, it behooveth the recipient to read it. :)

Incidental disclosure is what makes it possible to take care of two people separated by a curtain, too. I know they put the fear of God into students about HIPAA, and that's appropriate, but it has to be with reference to the actual rule, not what somebody told you she learned in an inservice or heard from her instructor or in the cafeteria and probably garbled. Learning that gossip and rumor run rife in organizations is part of learning to work in one; always check it out. Think of it like using Snopes, like a matter of internet hygiene. Mental floss, maybe. :)

It is trivially easy to read the HIPAA FAQs at www.ocr.gov. Check them out and look at the sticky threads at the bottom here as to what are identifying data. You will feel better.

[iluvivt, BSN, RN]

The link is not working

[nurseprnRN, BSN, RN]

It is now (1738 eastern, Thursday)

HIPAA - Incidental Disclosures of PHI

http://www.hhs.gov/ocr/hipaa.

(sorry!)

[rn/writer, RN]

Wow. I was not expecting such common sense in a government directive. Good information to have. Thanks, EricJRN and GrnTea.

[Jory, MSN, APRN, CNM]

If the patient's have any type of bracelet, it is not necessary to review the medications out loud at all.

[rn/writer, RN]

If the patient's have any type of bracelet, it is not necessary to review the medications out loud at all.

If the bracelet can be used to verify name and date of birth, that part of the review does not need to be stated out loud. But the rest of the med review--name, action, dosage, times, and other pertinent info--should still be done verbally (unless the patient is unable to do this--then it needs to be done with their designated assistant).

The teach-back technique requires the patient to say what they are taking, why they are taking it, and all the rest. We're not reviewing the meds for ourselves. We're doing it for the patients.

Many misunderstandings have been clarified and mistakes have been prevented during this crucial step. Of course, we need to be as discreet as possible, but we don't want to omit such a valuable part of patient teaching in the name of keeping everything secret.

[iluvivt, BSN, RN]

Tx so much for fixing the link!

[Jory, MSN, APRN, CNM]

If the bracelet can be used to verify name and date of birth, that part of the review does not need to be stated out loud. But the rest of the med review--name, action, dosage, times, and other pertinent info--should still be done verbally (unless the patient is unable to do this--then it needs to be done with their designated assistant).

The teach-back technique requires the patient to say what they are taking, why they are taking it, and all the rest. We're not reviewing the meds for ourselves. We're doing it for the patients.

Many misunderstandings have been clarified and mistakes have been prevented during this crucial step. Of course, we need to be as discreet as possible, but we don't want to omit such a valuable part of patient teaching in the name of keeping everything secret.

I have never seen two nurses verify any oral narcotic in my career. They may come in and tell the patient what they are bringing, but reviewing it step by step? Never once seen it done.

I wasn't suggesting keeping it a secret, but at the same time, if you are using your 5 rights, it shouldn't matter if the patient is awake or in a coma. In a LTC facility, it would be different if it was the first time a patient was receiving the medication, but doing the whole review over and over again? Other than your normal checks, I don't see that it is necessary at all.