Loose visiting policies lead to HIPAA violations

[FireStarterRN, BSN, RN]

At our small ICU/Stepdown unit we have virtually unrestricted visiting and we give report at the desk at the nurse's station. At report time our unit secretary has not yet arrived, or has already left, since we are on 12 hour shifts and the secretaries are on 10 hour shifts. So, it's just 2 nurses reporting off to two other nurses.

We also have loose visiting policies, so visitors are routinely coming up to the desk interupting report. The other day the daughter of the patient who was too lazy to open her splenda packet appeared suddenly, and I'm pretty sure she overheard me discussing the patient's social history that included meth use at one time. I also was most likely making some editorial comments regarding the patients lack of motivation, and of her manipulative behavior.

It brought home to me the fact that unregulated visitors are big HIPAA violation risks.

[tntrn, ASN, RN]

I've had that feeling for some time now in our Family Birth Center also. Anyone can stand behind and read what we are charting on the computer systems we use. That's why I rarely, if ever, actually do it in the room. A couple shows up for induction, bringing along the entire family and half the neighborhood----I make them all go out for the admission assessment. No, I'm not the most popular nurse with the spectators, which is exactly what birthing has become, a spectator sport, and sometimes even the husband or SO doesn't know the truth to some of the questions I have to have.

Camera phones are another big violation, or potential for violation. Videos too, and with youtube being what it is, I shudder to think how quickly those films might be online.

[FireStarterRN, BSN, RN]

I think our ICU was designed before this loose visiting policy. Now, family members are overhearing many things that they shouldn't. I already sent note to someone in charge, but I have a feeling that nothing will come of it.

[jesskalpn]

Tntrn, my unit(Birth Center) also has an extremely lax visiting policy, making it extremely difficult to keep under wraps some of the patients' histories.

It is extremely annoying to have to deal with the ridiculous design of our nurse's station and attempting to keep information private when there are visitors hanging around the patient nutrition center that is right across from the station.

While I think it's beneficial for patients to have visitors, I think the shift to "family-centered care" is causing more problems logistically for the medical staff-from protecting information to having to work your way around the 5-10 visitors that seem to always be there.

Sad as it is, we've brought this up to management before and they just go into management mode, spouting the "family-centered care" and "patient satisfaction scores" mumbo-jumbo.

[Ruby Vee, BSN]

i've noticed the same problems. families wandering around the unit hear not only report on their own loved ones, but on the hiv+ meth addict next door. they also seem to love to hang out and listen when you're trying to re-orient the little old lady who thinks you've climbed in her bedroom window to steal her jewelry, or attempting to reason with the belligerent old man who counters everything you tell him with "you're a damned liar!" then they want to ask you questions about what they've heard.

family centered care can be a wonderful thing when the family is cooperative and has the patient's interest in mind. it can be a horrible thing when they come to the hospital to be entertained, fed and to monitor the nursing staff to "make sure they're doing their job." unfortunately, i see very few families of the former variety and all too many of the latter. i suspect part of it is the large, inner city hospital i work for and the patient population it draws. part of it can also be attributed to the generalized decline in good manners and common sense on the part of the population as a whole.

[Jo Dirt]

I don't know, I just wonder what the real reason for HIPAA laws are. If you think about it, every nurse who speaks in the hallway is violating a HIPAA law of some sort.

[BrnEyedGirl, BSN, MSN, RN, APRN]

Our ICU's have "open visitation" but they are closed and locked for two hours at every shift change!

[Ruby Vee, BSN]

our icu's have "open visitation" but they are closed and locked for two hours at every shift change!

locking the icus when it's not visiting hours would solve a lot of problems!

[FireStarterRN, BSN, RN]

I wrote an email to the HIPAA coordinator, here it is. We'll see if anything comes of it, I think this is a genuine concern.

Hi HIPAA coordinator, sorry to bother you again.,

I think that we are having repeated violations of HIPAA in the ICU since we give report at the desk and visitors are virtually unregulated. I think that the Unit was designed when visiting policies were much stricter.

In the Unit at report time, you generally have 2 RNs reporting off to 2 oncoming RNs. The RNs are on 12 hour shifts, 7AM-7PM. The unit secretary, when we have one, works a 10 hour shift and is not there at report time to help monitor things.

Since we have gone so strongly in the direction of family friendy, open visiting policies, the public basically comes and goes as they please. And of course patient care doesn't just cease during report, sometimes the nurse who isn't reporting off at the moment is answering lights, etc.

So what happened to bring this home the other day was that I was reporting off on a particular patient who had a pertinant social history that included prior methamphetimine use. Also, there was a complicated social services aspect of her care, and the patient definately had psyche issues, all of which I was relating to the oncoming nurses. All of a sudden I looked up and the adult daughter of the patient had arrived, and I'm fairly certain that she overheard what I had said.

I can't tell you how many times patients' visitors have walked up to the counter while we are giving report at the nurses station. Since we try to make our hospital a welcoming place, visiting is virtually unregulated, and the public has definately grown accustomed to this. It's not a problem in Med/Surg where report is done in a private room. But in the Unit report is done face to face, the patients are more complicated, the staffing is less and so forth.

The only solution I can think of is to restrict visiting during report, perhaps by installing a locking device on the ICU door and a new sign explaining the need for privacy during report. Otherwise people just walk up and can overhear what we are saying. I think the public can understand the need to protect privacy of information, especially since most people know the Federal Government is now regulating this.

Sincerely, jlsRN

[RN1982]

Speaking of camera phones, we had a visitor who went into another patient's room and took pictures of the patient. The patient was confused and had their gown up exposing everything. If the fact that the guy was taking pics of the confused naked patient wasn't enough, the guy's sister didn't think it was a problem..."He's only joking"....Security had to be called and confiscated the phone.

[BrokenRNheart]

Speaking of camera phones, we had a visitor who went into another patient's room and took pictures of the patient. The patient was confused and had their gown up exposing everything. If the fact that the guy was taking pics of the confused naked patient wasn't enough, the guy's sister didn't think it was a problem..."He's only joking"....Security had to be called and confiscated the phone.

How rude!

My last hospital had no visitation hours.

We could NEVER get through report without multiple interruptions and HIPAA - ya right. People would stand over you for the stupidist things.

I think we should have a place to speak privately without having people come up and hear our conversations or interrupt us. At least with report and this place added that to the mix of interruptions that took away from the job.

[MaryAnn_RN]

How rude!

My last hospital had no visitation hours.

We could NEVER get through report without multiple interruptions and HIPAA - ya right. People would stand over you for the stupidist things.

I think we should have a place to speak privately without having people come up and hear our conversations or interrupt us. At least with report and this place added that to the mix of interruptions that took away from the job.

When I worked in HDU we had a little room that we used to handover care. One RN would handover 4 patients, then another would come in and handover the other 4 patients. No problems with privacy there.

In ICU we can't do that so we ask all visitors to leave the unit for the duration of handover (we do two; one at the nurses station and another at the bedside). Visitors can use the free hot drinks machine etc in their waiting area. There are no exceptions made to this rule and it works well, we explain to the family on admission what the 'rules' are so they can plan their visiting schedules.