HIPAA violations

[Boolah]

Are these HIPAA violations?

1) Nurse has taken care of patient to include monitoring lab values. Next shift, patient is not assigned to her, but she wants to know how the patient did regarding lab draws occurring after her shift ended. So, she accesses the medical file to monitor the lab values, or other aspects of follow-up care. Is this a HIPAA violation?

2) In a small nursing home, the admissions clerk (not a nurse), joins in the case management meetings regarding patients. She then is able to confront a relative with a judgement regarding the patient's condition ("the patient is 150% better," versus the MD telling the closest relative that the patient should be hospiced). Is this a HIPAA violation? Are admissions clerks privileged to know the ongoing medical condition of nursing home patients? Does the original act of admitting a patient (and knowing why they are there) continue to extend the privilege throughout a stay? This has broader implications for general ward clerks in an acute care setting (you know you tell your clerk everything--she runs the unit :bowingpur)

I honestly don't know the answers, and I would appreciate some direction. Thank you.

[papmar]

I say yes to both. From my understanding, you should only know what you need to know to do your job.

[Okami_CCRN, BSN, RN]

I would say no the first scenario is not a HIPPA violation because you are in the position to know lab values and understand them. If there was something wrong and his/her nurse did not pick it up then you have the knowledge to bring it to light

On the second scenario I would say it is a HIPPA violation because she should have never confronted a family member. It is not in her scope to do something like that

[meownsmile, BSN, RN]

Yes, definately hippa violations. You are only permitted access to a patients records and/or information if you are directly taking care of the patient. Next shift takes over pertinent information and it is no longer legally accessable to you unless you are asked to care for the patient again.

Ward clerks are not part of the health care team with regards to medical information. They are not trained to interpret or understand what those values and reports mean so they are not to use or inform or interpret any of that information. Its kind of like a nurse reading a book about splitting the atom then thinking they can go do it and teach someone else to.

[TazziRN, RN]

1. Yes, violation because you no longer have a need to know. If you're curious you could visit the pt and ask if he's any better.

2. Not so much a HIPAA problem than scope of practice. Non-medical personnel can be a part of a team, but it is not in their scope to talk with family members about the pt's medical condition. That lies at the feet of the docs and the nurses.

[emnicams]

#1 is in violation. In our HIPAA section of orientation when I was first hired, they gave us a similar scenario in example of what NOT to do.

[xoemmylouox, ASN, RN]

This whole HIPPA thing has gotten out of control. I was told by a school nurse she is unable to inspect the heads of children for lice, due to it violating their HIPPA rights. I agree patients have a right to privacy, but this is nuts!

[gr8rnpjt, RN]

I have a HIPPA scenario that is not only scary but goes way beyond the boundaries that the drug companies consider themselves part of the treatment team.

My mother was in the doctor's office recently and saw a drug rep come in. He had knowlege of a certain patient that was put on one of his drugs. The doctor had taken the patient off the medication and somehow that rep found out from the pharmacy that the drug was discontinued. The drug rep was questioning the doctor why he took the patient off the medication!?!

Is that a HIPPA violation???

[Jo Dirt]

Homework stinks.

[pagandeva2000, LPN]

I think that once you are released from caring for a particular patient, there is no real need to go back into their records to further monitor them. If there is a situation where you have to do a late entry in the chart, however, you may come across some information that was not previously known to you...so, in that case, it can be sticky, but there was a reason why you had to re-enter into that chart.

I remember once, in my clinic, I drew blood from a patient and then, 4 hours later, I wondered if I used the right colored (and enough) tubes, because if not, some of the labs would not have returned. We have computerized charting, and I did re-enter because I wanted to just see if anything was rejected by the lab, and if so, I probably would have had to tell the doctor my mistake, and then, contact the patient to come in to have another sample drawn. It wound up okay, I used the correct colors and amounts, because the results were in (wasn't curious to know that, but my inquiry had given me access to information previously unknown to me).

[Boolah]

I thank you all for your responses. It would seem that HIPAA will curtail any curiosity or learning about real situations and patients responses to treatment. Well, I am too busy to obsess over it, but I think it is a shame. It's not the same as accessing a famous person's medical records to gah-gah (boy, you'd think those nurses would have learned by now!)

Thank you for pointing out the scope of practice for the admissions clerk. I hadn't considered that. That's helpful. There is a lot of info that the clerks know from just doing their jobs, without even discussing anything about a patient. Trust me, they're in the know anyway.

The aspect of HIPAA that I dislike most is not being able to tell a relative how the patient is feeling by telephone. I have been cursed at and have had to listen to very bitter people who cannot get around my HIPAA routine. And the follow-up phone calls by alternate relatives are time consuming. And, I dislike hearing, "Everybody else tells me. You're the only one!" Okay, I'm the devil....but I'm not getting fired because of HIPAA...sorry!

Anyway, thank you again.

[justme1972]

I also say yes to both.

In #1, it's the responsibility of the next nurse assigned to the patient to read the chart and review the lab values.

In #2, the admissions clerk is not a medical professional, is not assigned a patient (entering information is not the same thing), and confronting a relative about a decision that was made (that may or may not be a decisionmaker) is disclosing information regarding the patient, regardless of outcome.

Boolah...

Does your hospital not use numbers assigned to patients so that they may get information by phone? That is what the hospitals do around here. They assign a special number and whoever knows that number can get information on the patient when they call. They give the number to the person left in charge (if they patient cannot speak for themselves or the patient will give permission) and they can decide who gets the info and who doesn't.

I don't think it's reasonable to require someone to be present to get information on a loved one, especially if that person is a mother, or a child of a geriatric patient and is arranging care.