HIPPA Question

[-Emma-]

There's been some recent confusion over HIPPA violations regarding nurses following-up with transfered patient's. Our secretary knew a patient who was recently admitted and subsequently passed away. She called in checking on the patient and was told by a nurse that he passed away. Our manager found out and told the nurse that she could have violated HIPPA and was stripped of charge nurse duties. I don't know what happened next, but the nurse has since quit. This all happened within a month (I believe.) So, my first question is: Did the nurse violate HIPPA? Was it because the secretary knew the patient/family?

So, now us other ICU nurses are curious. Can we give information to ER nurses who are curious as to what happened to a patient they admitted some other day? Can we call a medical unit to see how our patient is faring who was transfered?

We had in interesting case with a young woman who had extreme headaches and started with some twitching. The neurologist brought the patient to ICU to do a spinal tap because she would not do it without the consious sedation. We've been curious what she may have had and how she's doing. Is it OK for us to check?

Thank you for your help in clarifying these issues.

[ukstudent]

Yes, she broke HIPPA, and no you can't ask questions out of curiosity.

[catlady, BSN, RN]

I think whoever disciplined that charge nurse was a little harsh. What privacy rights exist for the dead? They're likely to end up in the newspaper anyway.

http://www.rtnda.org/foi/hipaafaq.shtml

Q. Can a hospital confirm that a patient has died?

A. If the patient is still within the facility, then it is arguable that death is a condition that may be disclosed as part of the directory information.

As far as asking about patients who've been transferred, I suspect it's probably not ok. There has to be a need to know, and you don't have a need to know once they're off your unit.

[flashpoint]

It all sort of depends. HIPAA allows release of information without permission from the patient or their representative for purposes of treatment, payment, or operations (TPO). ER nurses following up with ICU or floor nurses generally falls under the operations part of TPO...sure, some of the reason you follow up is curiosity, but you also follow up to see if treatment given in the ER was effective, what did or did not help, wtc...it can be considered a QA process and it is not a HIPAA violation.

The secretary calling and getting information was probably a HIPAA violation. There is a clause in the HIPAA regulation that allows for a nurse to use common sense when disclosing information. The best answer is always to tell people inquiring about patients to call the family...that would have been the safest thing to do in this situation (our favorite thing to say was always "We don't have a paitent by that name."). There are situations where a nurse can release information to people that aren't family, etc. We had a young lady come into the ER after an MVA...she had no ID on her and she was unconscious. A staff member recognized her as a friend of her cousin's daughter...she ended up calling her cousin to get the girl's last name and parent's phone number. She simply told her cousin that there was an emergency and she needed to reach the girl's parents...information was release to someone who didn't have a "right" to it, but there was no violation.

[mel1977]

We are in an acute rehab facility and if we send a patient to the ER then we can call and ask but it is a need to know based on the fact that the patient is still admitted to our facility. If they had been discharged, then they are no longer under our direct care and that would be outside our abiility to call. I assume it would be the same. I think this would be a great question to ask who ever is in charge of your HIPPA regulations to clarify so no other nurses fall to this. HIPPA is such a fine fine line. People break it every day without even knowing it! I have had to catch myself on a few occassions. Esp when a patient asks about their roommate, like what happened. I hate saying "I'm sorry, I can't tell you that" when the roommate is right there. I have to say"ask your roommate, he/she can tell you"./ I understand but man, it is easy to break the rules.

[hogan4736, BSN, RN]

it's HIPAA

[jodyangel, RN]

I think its out of hand actually. Health care personel can share information as needed between facilitys as Long as the patient is still YOUR patient. When you send a patient to the ER, even if they're admitted you have some rights. He or she is still your patient even when in the hospital. They're coming back.

So when I send a pt. to the ER, and I call and the nurse sometimes says she can't tell me what they're admitted for, I fume. Sometimes we call to see how they're doing in the ICU for instance. Or want to know if they'll be coming back soon. To me its not a big deal, because this is just between health professionals taking care of the patient.

[Noryn]

HIPAA just frustrates the hell out of me. I personally dont think we should be able to give out any information at all, that way I wont have to be threatened with some outrageous fine that I would never be able to pay. We could even get it to the point where HIPAA would be a one word phrase--meaning something like, "Are you crazy, I cant tell you that, I will lose my job, my home, get put in prison!" Just think the time we would save and there wouldnt be any room for error--a patient asks are the results of my test back yet? You could just say, "HIPAA!" We all hate talking to doctors at times so how nice would it be when they are asking you a million questions to just say, "HIPAA!"

I get so damn angry over things like this because it is making our healthcare system here in the US a joke. Pts dont get bathed, turned or taken care of because the nurses have to deal with crap like this. Lets take a nurse from the floor and make them the HIPAA compliance officer! The patients will never miss her/him anyway.

Heaven forbid a caregiver caring about a patient. Because we dont want to violate HIPAA! What the heck us nurses will eventually be programmed by administration. "Must do task at hand, unable to show emotion!"

I dont mean to rant at anyone, certainly not the original poster as these are very valid questions to difficult situations. Cotjockey in my opinion hit the nail on the head.

There often is no definate answer but a good rule of thumb is this, if it is out of curiosity it is probably a HIPAA violation. It if involves a question of care then it should be ok as long as there is a legitimate reason for the question.

[TazziRN, RN]

At our facility we do follow-up calls on pts transferred to tertiary cares. Most nurses will tell us the basics (current condition, expected treatment, etc.) when we explain that this is an official f/u to close out our paperwork, and it's also quality of care issues....did we miss anything? Some nurses are not comfortable saying anything beyond the immediate condition so we log "No more info given by nursing staff r/t HIPAA."

As for employees calling to find out about pts, it's a no-no. If you do not have a NEED to know, you should not be calling.

[BittyBabyGrower, MSN, RN]

We have to have a name of someone from another hospital or department that will be calling for info. HIPPA is a pain in the rump sometimes!

[Antikigirl, ASN, RN]

We too have a code for these types of situations on the phone. You call and say that you/or family wish to bring something to the patient, and if you are to leave it at the nursing desk or is the patient accepting visitors.

If they are dead, they are "no patient by that name is on this floor". If they are still with us, they will give a reponse like "the patient is not accepting guests at this time (means not going well), or even "leave it at the nurses station" (again not doing so well). Or you can get the cheery..."sure come on down and they will be happy to see you".

BUT...if you think about it, this information is NOT a need to know...therefore it is a grey area of HIPAA and grey areas typically are a no no to be safe. I had a pt that was transfered to the ICU after my shift and the only question I could really ask was about my care of the patient and reporting off to the next nurses about some helpful advise of things I did to help her personally. However, I really didn't...sooner or later I would proably find out..and I did...two weeks later she was brought back to my floor doing fine :). But I didnt' ask at all just in case because my knowing her condition wasn't a need to know for her care...