HIPAA violation?

[LibraNurse27, BSN, RN]

Hi all, Today a bunch of nurses on my unit (including me) had to talk to our manager about a possible HIPAA violation. Last week we had a "high profile" patient from the jail. He was in the news for a fascinating/horrible crime that he committed. Everyone in the public knew his name and the details of the crime. But the hospital he was at was not public knowledge. When he came in his chart wasn't flagged as one that limited people can open, but later in the week it was.

When he came in he was lethargic and had 2 officers in his room so he was not a 1:1 for nursing. The house supervisor decided mid-shift that he had to be a 1:1 because of what he had done. Didn't make sense to any of us but she insisted. We didn't have enough staff and we had to keep taking turns doing the 1:1 while people took breaks. I had to sit with him for a bit so I opened the chart and looked him up. A lot of other nurses did too because we were trying to figure out why he needed 1:1 since our staffing is already not great.

Long story short management thinks we opened the chart to snoop. All of the "juicy" info is on Google, so I don't think anyone was doing that. They asked each of us for an explanation of why we opened the chart and since then no news. I don't think they would fire so many people, but you never know! One nurse was fired last year for opening her friend's chart when he was in the ER so I know it's possible to be fired for HIPAA. No one "leaked" the info about him being in our hospital or told any of his medical info the the media. What does everyone think? I am so worried!

[Kooky Korky, BSN, RN]

It seems to me that you have need to know medical info about a pt in your care.

Your Admin sounds like an idiot.

Good luck.

You could be find for HIPAA, too, and maybe there could even be action against you from the state licensing Board.

[kp2016]

All the nurses who were in the room for the 1:1 are fine as they were directly involved in the patients care. If I was with a patient who was lethargic I would be looking at the chart to review what meds had been given, lab work, vital sign trends, admitting diagnosis etc. Even if I were only relieving the primary RN for a break I would still review the chart as I have a duty of care to the patient as soon as they are in my care.

If I were you I would point that out to your manager ASAP. I would not accept a HIPAA warning in my file. The fact that other nurses were curious is nothing to do with you.

Anyone who was trying to work out why he required 1:1 is probably out of luck. It’s possible the hospital may choose to issue them a warning and mandatory HIPAA training.

[JKL33]

I would take a hard stance immediately and tell them you were an RN assigned to this patient's care and that you have every intention of rigorously defending yourself.

For goodness sake don't make excuses like he wasn't flagged at first and then he was, or 'we needed to see why the supervisor thought this was necessary.' That's the kind of panic-grasping that will fry you.

That's how I'd defend myself. BUT, I have to say, would I have perused through his chart if I were there as a sitter? NOPE. You all might be in trouble. Why do people do this?? Whyyyy. I would've been in his chart only if I needed to chart something. Or maybe to look at his summary page where care-plan items are displayed (diet, activity, etc.) in order to facilitate proper care on my part. Sitters actually do not need to do intensive chart reviews to review supervisors' decisions.

Learn how the system works and understand that reactionary stupidity about stuff like this abounds on all levels, from the one sitting at the doorway all the way up to the privacy officer [additional thoughts about privacy officers retracted ?]. Stay the h away from all of this nonsense whenever you can. Go out of your way to avoid it.

[LibraNurse27, BSN, RN]

Oh no I didn’t mean the chart not being flagged was an excuse, and luckily I didn’t say anything about that to my manager. I think you’re right, if you’re just covering a 1:1 don’t open the chart, and if you “might” be getting assigned, wait until it’s final. I hope looking at a chart and not doing anything with the information doesn’t cancel out 7 years of being a good nurse, but I know it happens all the time. I’m thinking the worst that could happen is a HIPAA class since so many people are on the list, but you never know! ?haha I would love to hear your views on privacy officers!

[ljo28, BSN]

I think it was wrong on the part of the management that they order 1:1 and don't tell staff why the patient needed 1:1. In order to provide the best care, the staff need to know the reason for the 1:1. It could be for suicide precautions, agitation, drugs, physical violence, or whatever reason it might be, but the staff taking care of the patient should be aware of it. Especially if it was all nurses covering the 1:1, it is all the more reason that the they be aware. Him being high profile does not have any thing to do with it. The staff need that pertinent information, and that is it. What if the patient was high profile. He was in the hospital for a reason and the staff who is taking care of the patient should know that in order to give the best care to the patient safely and effectively, regardless of his social status.

I think the management is at fault here for being secretive. This is like putting the staff and patient at risk.

[JKL33]

^ That's the kind of information one would expect to receive during a brief safety-attendant hand-off report.

25 minutes ago, ljo28 said:

It could be for suicide precautions, agitation, drugs, physical violence, or whatever reason it might be, but the staff taking care of the patient should be aware of it.

I'm not going to say they should never need to be in the chart, but at the same time let's be realistic: This patient is going to be directly attended by officers throughout his stay. His nursing plan of care is under the purview of the assigned RN. The staff at the door need to know things like his current behavioral state, his diet and activity orders etc., and should follow the "safety case" protocols and expectations just like they would with any safety case.

Staff shouldn't be banned from opening a chart merely because their role was safety attendant/sitter--that wouldn't be appropriate either. But they all should be expected to limit their chart actions to those that pertain directly to their assigned role. It wasn't the role of any of them to figure out if the supervisor's decision was appropriate.

And heck yes, some of them (maybe not the OP) opened the chart to read all about this person solely because they felt "covered" in doing so by virtue of being assigned to the door. That is dumb and is the kind of mindset that makes miserable privacy officers feel justified.