In my opinion, if we nurses have a patient whom we transfer to another unit or facility, we should be able to obtain information as to the subsequent course of events and treatments of the patient. This information would be valuable to nurses so we can better understand the disease process and thus strengthen our nursing practise.
For instance, let's say I have a patient whose case is too complicated for my small hospital, who has a certain set of signs, symptoms, lab values, etc. The patient then gets transfered to a larger, better equiped facility for further evaluation and treatment. I think finding out the outcome of events would be extremely valuable to me, not because of idle curiousity, but because it would make me a more astute practitioner. It would broaden my perspective and give me a better grasp of what signs and symptoms led to what outcomes.
Therefore, I think we nurses have a 'need to know' the eventual outcomes of patients, even when they are no longer under our direct care. Knowing outcomes will make us better nurses!
Evaluation of outcomes is not curiousity, it's part of the nursing process.
Now let's not be disingenuous here. I've seen this happen over the years and many times it is simple curiosity. That's just human nature. I wouldn't go as far as to term it stalking, but I must say anonymurse makes a pretty strong argument here. And I wonder how some would feel about this if were they were the patient.
HIPAA allows for release of information related to QA/QI activities. That falls under the healthcare operations purpose specified by the rule. However, it doesn't allow for follow-up on one individual patient by a staff nurse, as this really isn't the best way to bring about QI anyway.
I understand what you're saying, and I get that EVB princaples are in effect, however...
Doesn't the individual nurse need to know if her instincts were right/wrong, if her own judgements were correct/incorrect? I'm disappointed that HIPAA prevents us from building our own personal expereince based knowledge.
I am a GN, so no experience outside of student clinicals - but I did follow up on patients I had as a student, and never had a clue that I was violating HIPAA. (I did it through my clinical instructor)
If something goes wrong as a result of our care, do we not hear about it due to privacy laws? Just wondering.
Evaluation of outcomes is not curiousity, it's part of the nursing process.
Lawbreaking is not part of any nursing process.
The shift we were assigned these folks is over and they're d/c'd.
These people are not our patients. They are private citizens.
We are not to do anything to them under any pretense, especially professional. And if we have to dress things up by invoking "nursing process," what part of "nursing process" is doing things to non-patients without their consent or knowledge?
I am a GN, so no experience outside of student clinicals - but I did follow up on patients I had as a student, and never had a clue that I was violating HIPAA. (I did it through my clinical instructor)
HIPAA does allow for some release of information related to education, so as a student things were likely different.
The problem with following up on one patient is that, even if they died immediately after your care, it doesn't necessarily mean that you should do anything differently the next time. If your hospital CQI committee obtains and tracks follow-up information and determines that all of your patients are dying, now we're on to something.
Follow up on critical patients should come in the way of QA/QI reviews. The service that I fly for does quarterly QA/QI medical director reviews. The charts are reviewed and status post disposition information (how the patient did following transfer of care) is also reviewed. The good, bad, ugly, and specifics of patient care are reviewed with our director as well. I actually find these reviews and the input from our medical director very helpful.
However, I have yet to work at a hospital that has a similar process. Perhaps having a good QA/QI process where nurses can review the care and interventions delivered along with outcome information would be a good thing.
I know my service and several other services that transport patients will write and fax a follow up letter stating how the patient did during transport and will describe any additional problems encountered and additional interventions performed during transport. I think this is important for facilities to have as well. While, you could argue HIPPA on this practice, we must remember that the sending physician still shares some patient responsibility until that patient's care is taken over by the receiving facility.
HIPAA allows for release of information related to QA/QI activities. That falls under the healthcare operations purpose specified by the rule. However, it doesn't allow for follow-up on one individual patient by a staff nurse, as this really isn't the best way to bring about QI anyway.
You have hit the nail right on the head here. HIPAA does allow for QA/QI release of information.
HIPAA is so often misunderstood, and people have been overreacting to it since the beginning. (1997, dont tell me it didnt start until 2003, it really started effecting healthcare by 1997) Like many things the gov't does, it was something neccesary, but they overdid it and made it difficult to understand, and bad consequences too if you do. So people tend to react more conservatively in regards to HIPAA to stay out of trouble. But it makes everyones jobs more difficult thats for sure.
Refer to the Office of Civil Rights or the CMS websites when you have questions about HIPAA, after 10 years they have alot of good inormation on there, and it is resonably easy to find.
If it's a patient I transferred to our medsurg floor, or one they gave me, their nurse usually checks with me at some point and really, all they want, especially if they transferred a sick person to me, is to know if they (the nurse) did well and how it affected the patient.
I compliment or educate as needed, remembering that these are my coworkers and making sure they know I'm proud of their desire to become better nurses. Heck, I ain't always the brightest one in the bunch either. I let my director find out for me the outcomes of some dramatic ones that we ship to other facilities. She can do that in the name of education, on occasion. It's not stalking! I've asked the cardiologist about transfers but usually a simple "did he/she do okay?" and I get an answer. Since he's not talkative I don't ask him much, but hey, if I had to wake him up and print godknowshowmany rythym strips on her, and she was trying to die on the way out the door, I'd like to know did we do allright?
The nurses on our medsurg unit will come ask questions about the patients we gave them, if there's something they need help with or whatnot, and we help them. Nobody wants to screw up an assessment. I think the fact that our facility is so small makes us act like one big unit at times. We do have to watch our conversations so the families and housekeeping don't hear anything that truly isn't intended for other ears.
All my patients in the future benefit when I learn, via real cases, how to do my job better, when to call sooner, what signs and symptoms are leading where and how fast, etc. It's not just for happy fuzzy warm feelings and it's not for curiosity's sake. Lives are actually at stake, now and in the future, and I'm adult enough to know what stalking is and isn't. Knowing if I did well or could do better, isn't.
I have already mentioned this in another thread, I know it is different in the UK but if one of my patients is transfered to ICU then I like to keep updated on that patients progress, firstly because I want to know if there was any more that I could have done and from a learning perspective but also because I spend quite some time with my patients and in that time a relationship and trust builds with the patient and family. If I am spent time explaining to the patient and family what is happening, providing support whilst they are distressed then I think that they appreciate knowing that the staff who have worked so hard with and for them in a ward environment takes an interest afterwards. Then if / when the patient returns to the ward that support can be continued with an understanding of what the patient and thier family have experience whilst on ICU.
For example, caring for a post operative neck surgery patient who bled and needed to return to theatre, post op went to ICU. WHilst there had a failed extubation and obstructed her airway requiring a surgical tracheostomy.
This patient was very difficult on return to the ward because she kept having panic attacks and waking up extremely frightened. All of which is understandable but having the knowledge of what happened whilst not in my care gave insight into her experiences and allowed me to empathise and support her further.
I don't think this is stalking or breeching patient confidentiality but it did allow me to care more effectively for this particular patient.
Why can't they follow someone's treatment to see the outcome of interventions, doctors, medications, etc. It would give them the "evidence" in their supposed "evidence based" practice. Why would you have to have a name attached to them. Just a dx and treatment, hospital, provider, time limit, floors pt was on, etc. This could be like a giant clinical "trial" of treatments.
Maybe an IT or Informatics person could figure something out like this with a "tracking #" for the Pt. Then anyone who is treating a similar condition (doctor or nurse) could have access to this database to see what is the statistically "best" treatment with the best outcomes. Almost everywhere is computerized now, charting, orders, med admin. etc. It shouldn't be too terribly difficult to do in the future.
Seems like it would help patients and providers. That knowledge would truly be power for the patient and the provider.
jlsRN - absolutely agree with you. b/c fewer admissions of certain cases, short stays, etc AND HIPPA, i think our knowledge pool is shrinking.
nursing students have less or no exposure to many of the pathologies that we older nurses saw every day. it is bound to have a negative impact upon their/our knowledge.
As a patient i would be angry if a nurse gained access to my health care information for personal gain. This is a violation of my rights.
I think, that as a patient, I would not be angry that a nurse "violated my rights." Likely, the patient would not even know. But, if, as patient, I DID find out that a nurse who had cared for me previously had followed up with my case, I think I would be flattered, not angry, that the nurse in question had cared enough to find out how I was doing.
On my unit, there are people who spend weeks with us. We get to know their spouses, children, extended reletives, their personalities, their quirks, their dietary likes and dislikes, how warm they like their room, and how often they go to the bathroom.
Of course we would like to know how they are doing once they leave our floor. We would like to know if they ever went home after that TCU or if they went to a NH, or if they were ever weaned from that feeding tube, or (in the case of CA patients) how their long-term prognosis looks.
I don't think that our patients would be upset to know that we cared enough to want to see how they are doing once they've left our care.
EmmaG, RN
2,999 Posts
Now let's not be disingenuous here. I've seen this happen over the years and many times it is simple curiosity. That's just human nature. I wouldn't go as far as to term it stalking, but I must say anonymurse makes a pretty strong argument here. And I wonder how some would feel about this if were they were the patient.