Someone in my charts....

Anonymous865 · May 17, 2016

You are absolutely correct. It is a HIPAA violation to look at someone's PHI if you are not providing them care. If you are providing them care, you can only look at the areas of the chart which are revelant to the care you are providing.

Report whoever is doing this.

Anna Flaxis, BSN, RN · May 17, 2016

I disagree. In a small department where you are each others' backup, I think it's important to be familiar with all of the patients on the unit. In the ED, while I have my assigned patients, I need to know who else is in the department and why they're there, and what the plan of care is, because we back each other up- I may or may not end up doing any care on someone else's patient, but I should be aware of what's going on in case I am needed to do so, especially since we don't have a charge nurse.

As House Supervisor, I don't actually provide any care (most of the time), but I do review the charts to know who is in the hospital, why they are in the hospital, what the plan of care is, any issues or concerns, that core measures are being met, and what the discharge plan is. I also review charts of ED patients to be on the lookout for potential admits.

So, there are reasons that are perfectly legitimate and not violations of HIPAA for someone not directly providing care to be in the patient's chart.

Maevish, rather than being passive aggressive and dropping hints, have you directly asked your co-worker why they are reviewing the chart?

TriciaJ, RN · May 17, 2016

I'm with OP on this one. If you don't get breaks, that means no one relieves you, so who needs to read the chart? If the coworker was just too busy to take the patient, why does he have time to peruse the chart? If he has that kind of time on his hands, he needs to be given something to do.

A legitimate reason to read the chart is one thing. But I think the coworker needs to explain how his behaviour isn't a HIPAA violation.

Anonymous865 · May 17, 2016

I disagree. In a small department where you are each others' backup, I think it's important to be familiar with all of the patients on the unit. In the ED, while I have my assigned patients, I need to know who else is in the department and why they're there, and what the plan of care is, because we back each other up- I may or may not end up doing any care on someone else's patient, but I should be aware of what's going on in case I am needed to do so, especially since we don't have a charge nurse.
As House Supervisor, I don't actually provide any care (most of the time), but I do review the charts to know who is in the hospital, why they are in the hospital, what the plan of care is, any issues or concerns, that core measures are being met, and what the discharge plan is. I also review charts of ED patients to be on the lookout for potential admits.
So, there are reasons that are perfectly legitimate and not violations of HIPAA for someone not directly providing care to be in the patient's chart.
Maevish, rather than being passive aggressive and dropping hints, have you directly asked your co-worker why they are reviewing the chart?

You make some good points.

I don't think from OPs description that he was reviewing the chart to familiarize himself with the patient so he could back up the assigned nurse. When the OP asked him if he needed anything or wanted to take the patient, I would have expected him to say, "No. I'm just getting up to speed on your patient so I can cover for you."

Then when she told him to get out of the chart, he did. If he had legitimate need to be in the chart, I would have expected him to say, "I need to finish reviewing xxx in case you are tied up with a patient when this patient needs help."

I agree that asking him directly why he is reading the chart on a patient assigned to you would be a more effective approach,

westieluv · May 17, 2016

There is also the possibility that this ICU is so tiny because it is in a small hospital in a small town where everyone knows everyone and the other nurse was just being nosy. He certainly didn't seem to have any interest in caring for this patient, so why did he need to be in his chart?

I'm with the PPs who mentioned that this is a HIPAA violation and he needs to be reported, because it is a violation and this nurse needs to know that. He could end up costing himself and that hospital a lot of money and headache someday if he continues this practice.

Been there,done that, ASN, RN · May 17, 2016

Looking at other charts is most likely the norm in this unit, not just directed towards travelers. Doubt it is a HIPAA violation.

You need to knock off the passive -aggressive response. Reporting something on your last day.. might come back to bite you.

westieluv · May 17, 2016

I just started a new job with a large dialysis company and had to go through all of the federally mandated HIPAA training just yesterday. it is a violation of HIPAA for anyone to look at PHI of a patient unless they are assigned to give care to that patient or otherwise connected, e.g., a unit clerk needs to fax someone's labs to their physician's office. Based on what the OP said, this other nurse had no reason to be in this patient's chart, and we can only go by what she said in this case.

I have never had a job, at least in the past decade or so, where this being a huge HIPAA violation was not stressed in the training phase. Companies take this behavior very seriously, and I have seen people get fired for it.

Maevish, ASN, RN · May 17, 2016

I disagree. In a small department where you are each others' backup, I think it's important to be familiar with all of the patients on the unit. In the ED, while I have my assigned patients, I need to know who else is in the department and why they're there, and what the plan of care is, because we back each other up- I may or may not end up doing any care on someone else's patient, but I should be aware of what's going on in case I am needed to do so, especially since we don't have a charge nurse.
As a House Supervisor, I don't actually provide any care (most of the time), but I do review the charts to know who is in the hospital, why they are in the hospital, what the plan of care is, any issues or concerns, that core measures are being met, and what the discharge plan is. I also review charts of ED patients to be on the lookout for potential admits.
So, there are reasons that are perfectly legitimate and not violations of HIPAA for someone not directly providing care to be in the patient's chart.
Maevish, rather than being passive aggressive and dropping hints, have you directly asked your co-worker why they are reviewing the chart?

Yes I have (he's bored) and he butts out when I ask him to. There are never any breaks and the other nurses only provide care/help me when I ask them to (which is perfectly fine), but since they aren't ever providing care for my patients, I don't see any reason for any of them to be in my charts. As I said, the guy gets out of my chart when I ask him to, but that's beside the point because he (and everyone else) keeps doing it.

As house supervisor and other areas of nursing I completely understand that. When I was a charge nurse I had to glance over charts to make sure I knew what was up if I was breaking someone or going to bed control. However, there are no charge nurses or floats nurses here and I don't go into charts where I'm not involved directly with the care and I didn't know people actually did that (supervisors, charges, etc aside).

If they were doing audits or something like that, that would be one thing, but they're not and it just feels wrong. I'm cool with a quick report sheet that some hospitals do where you write code status, why they're here, activity, restraints, etc, but they don't do that here. I guess I've never been in an ICU where things were so slow (it really is tedious here at times) cause no one else has had the time to be nosy anywhere else I've worked :rolleyes:

xo

Maevish, ASN, RN · May 17, 2016

Looking at other charts is most likely the norm in this unit, not just directed towards travelers. Doubt it is a HIPAA violation.
You need to knock off the passive -aggressive response. Reporting something on your last day.. might come back to bite you.

So it's legal because it's the norm? One of the guys that does it is also a traveler so I don't know what his issue is. If something is against the law it's against the law, right? When I worked in Oakland (or anywhere else for that matter) no one had the time to look through charts they had no business being in because they were busy working :sarcastic:

The passive aggressive thing was just the one time (the first time he did it) because I assumed he'd be like a normal person and say something like, "Oh, I'm sorry, I was just _______", but it didn't work and I've not done that since.

I'm just trying to see how I'd defend myself in court if I were any of the other nurses doing this (and one girl actually charted on my patient by accident because she was looking through my chart instead of doing her own work).

It's just frustrating and if I can't say something on my last day, then when can I? If I were the manager I'd want to know.

xo

calivianya, BSN, RN · May 17, 2016

It really depends on your unit's work environment and policies.

At my job, we have to check off each other's protocols in the chart. I've had days where I was looking through protocols on four or five other nurses' patients. Did I provide care myself? Not exactly, but someone had to check their protocols. I've also hung other nurses' meds plenty of times and charted assessments on other nurses' patients while they were drowning. It is common behavior in my unit to have charts open that aren't your patients' charts, and we have plenty of legitimate reasons to be in there.

It would almost be harder to prove someone didn't have a reason to be in a chart than to prove that they did have a reason where I work.

quazar · May 17, 2016

On my unit it is expressly forbidden to access a patient's chart if you are not providing direct care. They have a feature on EPIC that gives a warning and everything if you accidentally click on the wrong patient.