Published Apr 25, 2020
rachweys123
1 Post
Is it a violation to open a previous patients chart? Last night, I had a very busy shift and when I charted, I went through it so quickly with out double checking it. I woke up this afternoon, feeling like I had missed something on my group of patients and reviewed my patients notes and charting to make sure I charted/documented correctly. Now my hospital allows you to access their system from home, so I did it all from home. While I was in their chart, I did go over how the day shift managed with the patient. But I'm just not sure if I violated HIPAA by going over their chart/documentation from my previous shift.
please help. I'm very nervous I might get terminated for this.
beachynurse, ASN, BSN
450 Posts
If you are no longer involved in the patients care, you really shouldn't be looking through the chart. Only care givers involved in care should have access. I don't know what your facilities policies are as far as going back to review your own charting, especially from home, I would probably look into that.
JKL33
6,952 Posts
Checking your own charting for errors and omissions is absolutely not a HIPAA violation, although if you feel the need to do so it's probably wise to get an official okay (depending on the culture and expectations of your workplace) because of the damage that can be done by those who don't know what they're talking about or who purposely misrepresent the nature of HIPAA.
However, perusing on through to see what subsequent shifts have done with your previous patient is on much shakier ground; you are way more likely to hear the idea that at that point you had no "need to know."