Hippa rules

Jolie, BSN · May 7, 2008

Really? It was my understanding that even before HIPPA, patient information was considered confidential and only to be shared with necessary/approved parties. The difference with HIPPA, I thought, was that it legally made it a CRIME to breach that confidentiality.

Just because someone has a report sheet does not mean that they are going to share the information on it. If one left work with a report sheet and then proceeded to stop at the neighbor's house and relay all the details someone's hospitalization that was certainly actionable. But that's not what happens with report sheets. Some nurses prefer to keep them in a file for their own reference. I left work many a time with my report sheet in my pocket and simply tossed it in the trash at home. 20 years ago, no one cared. Now, I would likely be called on the carpet, even if no one else ever laid eyes on it.

With my first employer, care plans were not part of the legal record, so when a patient was discharged, the care plan was placed in the primary nurse's mailbox. We kept them as they were part of our annual evaluations. I'm sure that has changed!

jjjoy, LPN · May 7, 2008

Just because someone has a report sheet does not mean that they are going to share the information on it.

I totally agree.

If one left work with a report sheet and then proceeded to stop at the neighbor's house and relay all the details someone's hospitalization that was certainly actionable.

I totally agree here as well. Even without the report sheet, to share unauthorized details with unconcerned/unauthorized parties is not okay today and I don't think was considered okay even before HIPPA. Correct me if I'm wrong there.

I left work many a time with my report sheet in my pocket and simply tossed it in the trash at home. 20 years ago, no one cared.

I can see where 20 years ago, no one would've thought twice about the security of confidential information if thrown away and not shown or shared with unauthorized parties. But even 10 years, the facilities I was exposed to wouldn't allow any copies of patient records to be taken if identifying information was on it (eg had to cross name out) and would warn staff to be careful about taking any paperwork home that might have confidential patient information. I suppose the difference was that unless the patient diagnosis was something particularly controversial (eg AIDS), most didn't think a list with basic pt info (name, diagnosis, med) was considered something that needed to specially safeguarded.

I do think some of the data privacy regulations are a bit unrealistic. For example, given budget limitations (that is no one-on-one nurses in most units), to not write pt names on a central white board to indicate rm #, nurse, MD, etc hinders patient care. Last name, first initial isn't exactly the same as full name with the diagnosis & prognosis in red next to it. If someone is so afraid that an acquaintance will inadvertently learn of their hospitalization or what room # they are in, then they can make request EXTRA confidentiality measures (such as an alias) to protect their privacy. To limit the ready accessibility of certain basic information for EVERYONE seems to cause more problems than prevent problems.

But as I've noted before, I think it's the interpretation of HIPPA that has been so strict, not that it's guidelines are definitively so stringent.

Daytonite, BSN, RN · May 8, 2008

:typingHi,
I work at a LTC facility that has computer charting. One of the new nurses was going to take her hall sheet and census report, both of these have information like name , room number and admit date. She had made notes to remind her of the resident's diagnosis. I told her she couldn't take those home because of HIPPA, she told me she had a file full of notes and info from everyplace she had worked so that she could prove she had done her job. She stated she had lost a couple jobs because she couldn't prove she had done the treatment or ect, so now she keeps these to prove she has done her job. This was her second day on the job so I gave her the benefit of the doubt about taking personal information of our resident's home, but she in no uncertain terms told me she was doing it . I don't know if I am ticked off because of what she did or how much disrespect she showed to me. It is a violation of HIPPA isn't it??? Also I can access the computer program from my home with a password, so maybe it isn't such a big deal to take printed material out. Just was wondering. Thanks,

I took my brains home and saved them for years. They saved me several times when I got calls at home for things people had questions about. I'm an RN. I would resent being told my legal obligations by a coworker. HIPAA (not HIPPA) is violated when confidentiality is breached. There is no breach if the information is not seen by anyone else other than the person making those notes on their report sheet.

oldbutnewlpn · May 8, 2008

You would resent being told not to break the rules on your second day on a new job? I suppose you would be mad if someone reminded you to wash your hands after you had taken care of 6 residents and not come close to a sink or sanitizer. Maybe you think it is out of line for a co-worker to remind you to verify placement of a g-tube before inserting a feeding?? There are bad, unprofessional nurses everywhere. this one spent all evening telling me how her daughter had taken her purse and money, drug problem, I was worried that these notes(brain) would get into the wrong hands and we would all be in trouble. I am really surpised that so many nurses willingly break the rules and then get defensive when asked why they are doing it. Have a good day.

Daytonite, BSN, RN · May 8, 2008

you would resent being told not to break the rules on your second day on a new job? i suppose you would be mad if someone reminded you to wash your hands after you had taken care of 6 residents and not come close to a sink or sanitizer. maybe you think it is out of line for a co-worker to remind you to verify placement of a g-tube before inserting a feeding?? there are bad, unprofessional nurses everywhere. this one spent all evening telling me how her daughter had taken her purse and money, drug problem, i was worried that these notes(brain) would get into the wrong hands and we would all be in trouble. i am really surpised that so many nurses willingly break the rules and then get defensive when asked why they are doing it. have a good day.

it is not the job, or the role, of a coworker to tell a new employee "not to break the rules". that privilege and authority belongs to the managers and supervisors. an employee that would do something like this with a new employee instead of reporting it to the manager to handle is acting as a self-appointed boss, game playing, out of line and looking for some kind of leverage to hold over the new employee. the one in worse trouble to my way of thinking is the older employee who is picking on the new employee and if i were the manager (and i have been a manager and supervisor for some years) and got wind of it this older employee who feels that it is their job to quote or try to enforce job rules to a new worker is going to be front and center in my office for a little talk about their job duties and how new employees are to be welcomed and treated.

Jolie, BSN · May 8, 2008

it is not the job, or the role, of a coworker to tell a new employee "not to break the rules". that privilege and authority belongs to the managers and supervisors. an employee that would do something like this with a new employee instead of reporting it to the manager to handle is acting as a self-appointed boss, game playing, out of line and looking for some kind of leverage to hold over the new employee. the one in worse trouble to my way of thinking is the older employee who is picking on the new employee and if i were the manager (and i have been a manager and supervisor for some years) and got wind of it this older employee who feels that it is their job to quote or try to enforce job rules to a new worker is going to be front and center in my office for a little talk about their job duties and how new employees are to be welcomed and treated.

is it not the co-workers who orient a new employee? is it not the job of a preceptor to make the new employee aware of facility policies and procedures? is it not the responsibility of a preceptor to make an orientee aware of aspects of his/her practice that do not conform to facility policy and procedure, such as patient safety, patient care or legal issues? should the preceptor not address these issues directly to the new employee, and then involve management if the problem persisits?

i can't imagine working in any facility where co-workers are encouraged to report every issue directly to management without addressing each other first.

Mijourney · May 8, 2008

My concern with having protected health information in my car or home is that it is discoverable. Meaning that if one is involved in a legal situation and a warrant is given to go through personal property, then you are nabbed. I don't know how hipaa is impacting home health today, but in the past, it was easy to get a copy of the notes for the day and ride around with them in the car or have them at home. The only instruction I remember as far as paperwork at home was to keep it in a separate container with a lock. As far as the hospital goes, I have heard of physicians leaving with protected health information in their brief cases-mainly to use them as templates for future documentation. I don't feel comfortable with that action either.

jjjoy, LPN · May 8, 2008

It isn't always a clear line of how much is enough safeguarding of information. I agree that the main point of HIPAA is to protect patients from BREACHES in confidentiality. To be overly strict in when and how a health care provider can have access to patient information can actually HINDER patient care.

Thus, keeping one's report sheets for professional reasons (as learning device, to prompt one's memory in regard to patient care, etc) seems reasonable to me as long as full names or other definitively identifying information is crossed out and that information isn't otherwise distributed or accessible to the general public.

I can see the concern with discoverability of patient information. In regard to old report sheets, as long as definitively identifying information is crossed out, I don't see that as reasonable threat to patient confidentiality. If a person is driving around with patient records in their car, that becomes more tricky. Sometimes, it is necessary to transport a hard copy of a patient record (or parts of that record). That seems alright, too, as well. As long as that information doesn't remain in that vulnerable position for longer than necessary. So if a home health nurse will have such material in the possession for an extended period, they need to have a secure holding place for it until they can return the materials. (Even banks have to transfer cash sometimes and at that time, they are more vulnerable. There's no way to protect anything 100%. We have to decide how much resources we're willing to put into protecting any one particular item.)

However, if what is discoverable is a rumpled sheet of paper with several patient last names scrawled on it along with notes about their IVs, bowel movements, and pain levels, that doesn't seem to me particularly incriminating or a major breach of patient confidentiality just waiting to happen. That is in contrast to a nurse having files of photocopies of patient reports with their names attached or copies of case records with the name crossed out on each page but enough info it to be easy to determine who it is about. Information that if accessed by the wrong person COULD breach patient confidentiality in a major way... such as celebrities' rehab medical records, information that identifies HIV positive members of the community, etc.

I DO think it's unrealistic to apply all of the same rules of physical ownership to the arena of information. If you steal my car, I don't have the car anymore. If you are caught, the car is taken away from you. In contrast, f you learn my name, I still have my name. If someone gets in trouble for allowing you to learn my name, you still know my name.

I thought the main thrust of HIPAA was to protect patients from the threats of confidentiality breaches due to the increasing trend of storage of information on networked electronic media, where accessing information can be as easy a few computer keystrokes, as opposed to having to physically access the file. There's the threat of insurance companies combing through old records without patient consent trying to find reasons to deny coverage. There's the threat of people snooping into records (friends, celebrities, etc) that are of no professional concern to them. That's always been a threat and has always been wrong, but it was a lot more difficult to access that info prior to electronic records.

Daytonite, BSN, RN · May 9, 2008

is it not the co-workers who orient a new employee? is it not the job of a preceptor to make the new employee aware of facility policies and procedures? is it not the responsibility of a preceptor to make an orientee aware of aspects of his/her practice that do not conform to facility policy and procedure, such as patient safety, patient care or legal issues? should the preceptor not address these issues directly to the new employee, and then involve management if the problem persisits?
i can't imagine working in any facility where co-workers are encouraged to report every issue directly to management without addressing each other first.

the way employees interact with each other is also very important. as a manager i didn't tolerate one-upmanship, back biting, game playing if i saw it going on. i worked in long term care over the years and know exactly how this gets played in these facilities and i think there is more to the relationship between this new employee and the op than has been revealed. it is human nature sometimes to want to step on the new guy and put them "in their place". that's what i'm talking about as well here. that is wrong. what happened here is that the op got a very unexpected result in that this new employee stepped right into the game and gave back as good as she got. this frustrated the op who didn't get the upper hand she was looking for in the situation and is using the hipaa thing to blame for the whole thing going wrong.

orientation is helping someone learn and adapt to the facility's way of doing things. saying the words, "you can't take your hall sheet and census report home because of hipaa" has nothing to do with the facility way of doing things. while hipaa compliance might be built into the facility policy, an understanding of hipaa should be known by one and all licensed nurses anyway. there is no need or justification for anyone to be acting as a self-appointed enforcement officer of hipaa unless the people in charge are incompetent. there was no indication of that here. hipaa isn't violated until the information on hall sheets or census reports is viewed by unauthorized eyes or there is a specific facility policy that says you can't remove that information. i wouldn't have even responded to this entire discussion if the person's response to the new employee had been, "there is a rule that we are not allowed to remove our hall sheets or census reports from the premises. we get written up if we are caught doing it." notice the emphasis on using the word "we" and not "you". makes for developing a better relationship with new people. what caught my attention was the way in which it was done and the possible underlying motive for it.

jjjoy, LPN · May 10, 2008

"there is a rule that we are not allowed to remove our hall sheets or census reports from the premises. We get written up if we are caught doing it." Notice the emphasis on using the word "we" and not "you". Makes for developing a better relationship with new people. What caught my attention was the way in which it was done and the possible underlying motive for it

Great advice in regard to how to deal with policy enforcement & interpersonal communication! Thanks!