Not sharing EMR notes w patient/family

mmc51264, BSN, MSN, RN · Jan 26

Yes. We have an icon (EPIC) in the upper right hand corner of the note and you can click on it to choose to hide the note. There is a pop up that has you explain why you are hiding it (generalities) We are having HUGE issues with nurses, mostly new, that don't want to write any notes because with the new emphasis on transparency, pts can see our notes immediately which is causing some soft stalking (for example, one lady thought one of our nurses was adorable and a great catch for her granddaughter and she tried to find him outside of work). There a big deal about taking our last names off of our badges, but they can see notes with our full names.

I recently had to hide a note b/c pt had threatened to kill me. I obviously did not want it seen by pt.

JKL33 · Jan 27

mmc51264 said:

I recently had to hide a note b/c pt had threatened to kill me. I obviously did not want it seen by pt.

Not to be stupid but may I ask why? Just want to understand the line of thought. The patient knows they threatened to kill you, I assume. I would think they might suspect that such behavior will not go unnoticed/without further comment. Or was the note about some different piece of information that might have exacerbated things?

mmc51264, BSN, MSN, RN · Jan 27

JKL33 said:

mmc51264 said:

I recently had to hide a note b/c pt had threatened to kill me. I obviously did not want it seen by pt.

Not to be stupid but may I ask why?

If you read all of my post, our badges do not have our last names on them, the notes do. I didn't want the person to have access to my last name. You wouldn't mind a patient having access to your first and last name??? I work on an ortho/trauma unit and get a lot of gang/GSW victims. They are dangerous.

When's the last time your life was threatened?? Would you not take it seriously?

JKL33 · Jan 27

mmc51264 said:

If you read all of my post, our badges do not have our last names on them, the notes do. I didn't want the person to have access to my last name. You wouldn't mind a patient having access to your first and last name??? I work on an ortho/trauma unit and get a lot of gang/GSW victims. They are dangerous.

When's the last time your life was threatened?? Would you not take it seriously?

Dude take it easy.

I literally asked respectfully for additional understanding. It's okay to answer without coming unglued.

I did, in fact read all of your post and I guess my mind read them as two separate issues.

Sorrrrrrrrrry. Geez.

JKL33 · Jan 27

Spare me the drama. Almost my entire bedside career was in the ED where people are threatened every kind of way and not infrequently. And now as a primary care provider my name is on the sign, printed on people's RX bottles, all their paperwork, records, everywhere. And they are not some kind of magical patients that never have any ill intent.

mmc51264, BSN, MSN, RN · Jan 30

JKL33 said:

And they are not some kind of magical patients that never have any ill intent.

We have had 2 people assaulted, one died, in our parking area. People do act on theses things sometimes.

mmc51264, BSN, MSN, RN · Jan 30

JKL33 said:

Dude take it easy.

Not a dude. Sorry if you got offended, it's kind of mind-boggling that one would not understand that there are pts that have psych issues, many untreated, and there are hospitals in not so nice areas. I am glad that it's not something on your radar. Unfortunately, 2 out of 3 of our area's level 1 trauma centers are not in great areas and it can be pretty dangerous.

mmc51264, BSN, MSN, RN · Jan 30

JKL33 said:

Spare me the drama. Almost my entire bedside career was in the ED where people are threatened every kind of way and not infrequently.

Glad you are fine. So nice of you to dismiss others that have concerns. We had a nurse get shot in the ED. You win, you're tougher than the rest of us. Glad healthcare violence on health care workers is "drama"

JKL33 · Jan 30

mmc51264 said:

Glad you are fine. So nice of you to dismiss others that have concerns. We had a nurse get shot in the ED. You win, you're tougher than the rest of us. Glad healthcare violence on health care workers is "drama"

Look, we have both been around here for quite awhile. That's why I was taken aback by your first response to me, which seemed as if you believe me to be some random drive-by jerk not capable of a serious question rather than a long-term member who tries to contribute to discussions in a productive manner. You certainly came right back with quite a sarcastic answer to my post, rather than just providing clarification. But now this is getting even sillier: In your reponse asked me a question AND I ANSWERED IT truthfully and with what I thought was relevant information. Now you're saying that my answer is me trying to be tougher than the rest of you? I have never considered the ED to mean anything tougher. I wrote that because I think it is well known that people don't always behave quite politely in the ED, there are a number of that population who are not operating in polite mode at any given time, and who do threaten all kinds of things. That statement about my experience was not about me but about the type of populations I have dealt with--just as you included information about the population you deal with in your post.

I am not sure, where this is coming from. I initially asked you a clarifying question and you pretty much ripped me a new one. Prior to this as far as I can remember I have generally enjoyed your contributions here. I'm surprised and frankly not sure what more to say.

Sorry this went sideways.

I'm not sure how hiding a single note is going to prevent the patient from being able to learn your last name unless all of your nursing documentation is signed in the EMR with only "First name, RN." Is that the case?

subee, MSN, CRNA · Jan 30

mmc51264 said:

If you read all of my post, our badges do not have our last names on them, the notes do. I didn't want the person to have access to my last name. You wouldn't mind a patient having access to your first and last name??? I work on an ortho/trauma unit and get a lot of gang/GSW victims. They are dangerous.

When's the last time your life was threatened?? Would you not take it seriously?

You are not the only nurse to be put in jeopardy on the job. It's across the board happening. There was no reason to be snide when someone is asking for clarification . I had two death threats from patients. I reported one to the police and they took his gun away. The other was from a made Mafia husband in OB and I didn't mess with him at all! But both happened when I was seriously busy and I did my job and moved on. I didn't go onto social media to record any rude hysteria.

SpEdtacular, MSN, RN, EMT-P · Feb 1

JKL33 said:

I'm not sure how hiding a single note is going to prevent the patient from being able to learn your last name unless all of your nursing documentation is signed in the EMR with only "First name, RN." Is that the case?

JKL33 is correct. As someone who does EHR build, I can tell you your full name is all over the place. If you use Epic and assign yourself to the treatment team, they can see that. It shows in MyChart and often appears on the after visit summary, so not writing/hiding notes to hide your last name is misguided. Reasons available for hiding notes will vary depending on the organization. The reason you gave above is one example. Another might be surgical or anesthesia notes so the patient doesn't see them before speaking with the doctor after a procedure. I am pretty sure all notes have to be released to the patient eventually for regulatory reasons, so hiding notes just delays this. If it's a note's contents you don't want the patient or family to see, then I would say don't write a note.

If you are truly afraid a patient is dangerous or they have been violent towards staff, many organizations have a process for flagging that person's chart to alert other caregivers. If you are trying to record information to alert other caregivers, there are some types of documentation that are not patient facing (FYI flags) and that do not get saved to the chart (Sticky notes and in most cases ED trackboard comments and Hand Off activity notes) when the encounter is closed. My expertise is in Epic and build can vary greatly between organizations, but if you are at an Epic organization, one of the aforementioned features is probably available.