3 Pdn agencies in home.....Hipaa violation to look at chart?

JustBeachyNurse, LPN · May 30, 2015

Your agency clinical managers should be coordinating care and ensuring the plan of care is consistent. The 485 technically should reflect that the hours are shared between agencies.

The chart is owned by the agency and while likely not a HIPAA violation you need to follow policy regarding accessing charts owned by another agency. I've worked multi agency cases and we do not read the other agency chart. We do not handle their paperwork. The family requests med times. The clinical nurse managers coordinate orders, schedules, and other information to ensure accurate, consistent care. My agency is declared primary in both cases so our case manager disseminates new & changed orders to the other agency m

caliotter3 · May 30, 2015

Your nursing supervisor is taking the easy way out. I have heard this before. Usually we are told to only worry about what we do on our own shift, not to worry about what the parents do while we are not there, or what the other nurses do or don't do (unless it is documented). Same situation here, except with different agencies. I was on a case one time with two RN case managers. I was specifically told that I was to never contact the other RN. I was to discuss any problems with my RN supervisor and she would deal with the other RN. Fine by me.

I would make a point to bring this matter up with the family one time so that they are aware. If the family chooses to push the issue for better coordination between the agencies, maybe the agencies will start talking with each other. Make a memorandum for record that you informed the parents and your supervisor and go on your merry way. After all, you can't force all involved to do the right thing.

caliotter3 · May 30, 2015

On second thought, to be proactive, I would do the following: call the prescribing physicians to verify meds that are not included on your own MAR and take appropriate action to have those meds added, start a communication book for the home. If the other nurses don't want to use it, well, at least you will have proof that you tried to establish professional communication. Inform the family about the discontinued meds. Write up a communication note regarding this and keep a copy. You should also inform the PCP and document. Look at the med adm times that the other agencies are using. Pick the times that are used the most, based on who is in the home the most, and adopt those times. I always establish the med times in collaboration with the family, so there really is no problem in changing your med times to match the times used by one or both of the other agencies.

I'll bet a dime that the other nurses look in your book if they are bored. I sure would continue to check their documentation. To keep out of the supervisor's hair, I would discuss any discrepancies with the family so that you can say that the family entered a discussion about updating meds, times, etc. Supervisors are more inclined to go along with what the family wants than to support their nurses, as a rule, so it just makes sense to grease the wheel this way. HTH

BuckyBadgerRN, ASN, RN · May 30, 2015

Frankly, it sounds like a disaster waiting to happen. . Some big girl panties need to be pulled up and some lines of communication established.

MunoRN, RN · May 31, 2015

The information in the chart is actually the legal property of the patient, not any of the agencies involved, so unless it's at the direction of the patient, none of the agencies involved can legally prevent another agency from accessing their charting. Beyond that, it's disturbing that any of the agencies involved from all being on the same page just for the simple purpose of ensuring safe and effective care for the patient. I know at least in my state, a simple call to the Dept of Health would have them all over that situation and would have little sympathy for those getting in the way of basic good care.

JustBeachyNurse, LPN · May 31, 2015

The info belongs to the patient but the physical chart belongs to the agency. Same way a facility can charge for copies of medical records. The info belongs to the patient but the physical records belong to the facility/provider.

As far as coordination of care...the agencies should be working with each other to ensure accuracy of orders and consistency of care. Coordination of care is actually encouraged by HIPAA (not prohibited) so the nurse who accused you of violating HIPAA clearly is trying to intimidate you..but does not know what s/he is talking about.

In my multi agency cases I don't need to look in the other charts. The parents maintain a communication log and my direct clinical supervisor is efficient and effective at ensuring coordination of care. My agency is primary and covers most of the weekday hours and some weekends. Therefore order changes are most likely going to be received by a nurse from my agency. Our clinical supervisor then disseminates the order(s) to the other nurse managers. This is how it should be....

The parents have input in medication and treatment scheduling as they are the ones with primary responsibility for the pediatric client.

MunoRN, RN · May 31, 2015

The info belongs to the patient but the physical chart belongs to the agency. Same way a facility can charge for copies of medical records. The info belongs to the patient but the physical records belong to the facility/provider.
As far as coordination of care...the agencies should be working with each other to ensure accuracy of orders and consistency of care. Coordination of care is actually encouraged by HIPAA (not prohibited) so the nurse who accused you of violating HIPAA clearly is trying to intimidate you..but does not know what s/he is talking about.
In my multi agency cases I don't need to look in the other charts. The parents maintain a communication log and my direct clinical supervisor is efficient and effective at ensuring coordination of care. My agency is primary and covers most of the weekday hours and some weekends. Therefore order changes are most likely going to be received by a nurse from my agency. Our clinical supervisor then disseminates the order(s) to the other nurse managers. This is how it should be....
The parents have input in medication and treatment scheduling as they are the ones with primary responsibility for the pediatric client.

The physical paper the information is on belongs to the agency, but an agency can't prevent another agency caring for the patient from accessing (viewing) the information on that paper. If requested, they don't have to hand over the physical paper the chart is written on, but they do have to make the information available, either through copies, transcriptions, electronic transfer, etc, although they can charge a fixed amount for the physical transfer of info.

caliotter3 · May 31, 2015

Just let there be legal problems on the case, as being invited by the refusal to talk to one another, and we'll be quick to see what happens to all of this charting. I can't see the PCP signing three different 485's each recert period. It makes no sense that when there is an order change, that change is not made to one 485, that is used by all involved on the case. Some of this lack of communication is uncalled for. It would be prevented by a single 485 with each agency having their own heading.

Graduatenurse14 · May 31, 2015

I am new RN who works in a hospital but this sounds so dangerous and negligent by the agencies and the MD if he/she is signing different 485's.

Just let there be legal problems on the case, as being invited by the refusal to talk to one another, and we'll be quick to see what happens to all of this charting.

This. You all have to CYA as in court it won't go well to say that I was just following the orders of my supervisors.

smartnurse1982 · Jun 1, 2015

Just let there be legal problems on the case, as being invited by the refusal to talk to one another, and we'll be quick to see what happens to all of this charting. I can't see the PCP signing three different 485's each recert period. It makes no sense that when there is an order change, that change is not made to one 485, that is used by all involved on the case. Some of this lack of communication is uncalled for. It would be prevented by a single 485 with each agency having their own heading.

That is the strange part....he is signing 3 different 485's.

I am not sure if Physicians actually pay attention to those 485's.

I think they just a automatically sign it each cert period.

caliotter3 · Jun 1, 2015

I have been told many times that they just scribble their signature. I have encountered only one doctor who scrutinized the 485, making hand-written (and initialed) corrections no less. She, it stands to reason, was one of the best pediatricians I've seen. Talk to him about this. See if you can bring some resolution to at least that part of the problem. If your clinical supervisor was on the ball, she would take care of this matter, instead of instructing you to play deaf, dumb, and stupid.