Patients Viewing Nursing Notes In Real Time

[Tnurse24]

Is anyone aware of a new CMS rule that all nursing progress notes are to be made available to patients in real time? This is the default at my hospital, and it is a HUGE safety risk to ER staff who are already vulnerable to erratic and unpredictable behavior as well as wide open to the public. Is anyone else aware of these requirements? What is being done to protect individuals from potential violence or security issues?

[anewsns]

Apparently patients can't see flowsheets in EPIC so everyone knows. There are also exceptions to notes that could cause the patient to do harm to themselves or others, where doctors and case workers can delay how long it takes for them to see the notes. I do not believe nurses have the ability to delays though. I already know of some who received really bad news on radiology reports without having seen the doctor first. I think we should be able to use clinical judgment to delay release of information, even if it is only by a couple of days. Also what is with all the nurses who show virtually zero concern for other nurses safety?? There are ways of giving the patient good and fair care without hurting the nurse.

[trytounderstand]

Although there are circumstances and patients who would fly off the handle and react in inappropriate it is their body and their medical records.  They do have a right to view any report or notes and ask any questions they feel are necessary for their care. 

As far as patients not being able to see their records until the doctor has had a chance to talk with them.  There are instances when the patient having the report in front of them when they visit the doctor has prevented unnecessary surgery or treatment plans.  A second opinion was requested after the patient politely listened to what the first doctor wanted to do as far as surgery was concerned which ended in a totally different treatment plan.  With less chance of surgery complications.  Have also witnessed doctors trying to give a patient the bum's rush and talk them into treatment and tests that were not appropriate for their situation.  

[Wuzzie]

@trytounderstand Since you aren't a nurse there are nuances to this that you will not be able to understand. I'm sorry your health care providers are incompetent and unethical. Most physicians aren't, certainly not the ones I have worked with.

[anewsns]

1 hour ago, trytounderstand said:

30 minutes ago, Wuzzie said:

@trytounderstand Since you aren't a nurse there are nuances to this that you will not be able to understand. I'm sorry your health care providers are incompetent and unethical. Most physicians aren't, certainly not the ones I have worked with.

As far as patients not being able to see their records until the doctor has had a chance to talk with them.  There are instances when the patient having the report in front of them when they visit the doctor has prevented unnecessary surgery or treatment plans.  A second opinion was requested after the patient politely listened to what the first doctor wanted to do as far as surgery was concerned which ended in a totally different treatment plan.  With less chance of surgery complications.  Have also witnessed doctors trying to give a patient the bum's rush and talk them into treatment and tests that were not appropriate for their situation.  

Yes I can see what you are saying, trytounderstand, but it is our job as healthcare providers to help the patients make sense of the information. The patients have the ultimate, final say in what their care should be, but input from doctors and nurses (the ones with years of school and training) are an extremely important source of information. I, as a nurse, certainly don't know everything, so if I am having a problem in a body system where I only have basic familiarity, a test result leaves me with tons of questions. I have also educated nurse patients in family members in their neuro conditions where they felt much more informed and comfortable making decisions only AFTER a doctor and myself have spoken to them. Healthcare professionals often know in doing their own research that they also need specialized input. There are many, many patients with very minimal health literacy that are in an even more vulnerable position. 

I agree with Wuzzie that if doctors and nurses are rushing these conversations and not giving the patient enough time to understand, that is a failure of the healthcare professional and that is not something that is addressed with the CURES act. It should be addressed other ways. Its one thing if its a basic lipid panel or something, an entirely different thing to find out about a new brain lesion. Why we should be able to decide when the information goes out. The whole process of delivering information should be timely (no longer than a couple of days usually)  but doesn't need to happen the very instant results come in.

[SarahMaria, MSN, RN]

I work in a forensic psych hospital and have been told that, "all patients have the right to view their charts."  This is a major safety issue.  My patient was given such access, read my progress note, and then began to threaten/stalk me.  This patient has already committed murder once.  I feel that my safety is at risk.  

[MunoRN, RN]

26 minutes ago, SarahMaria said:

I work in a forensic psych hospital and have been told that, "all patients have the right to view their charts."  This is a major safety issue.  My patient was given such access, read my progress note, and then began to threaten/stalk me.  This patient has already committed murder once.  I feel that my safety is at risk.  

The CURES act as well as other laws related to patient access to their own medical record specifically excludes psychiatric / mental health notes.