Someone in my charts....

[Maevish]

I'm a traveler for the time being, but I've never had this problem before (on staff or traveling): This is a really small ICU and there're only ever two of us here at a time so it's been an adjustment (no legal breaks, no help, etc), but one thing is really starting to irritate me.

With the exception of two people, the nurses I work with are always in my charts. This is one of many examples I could give....A coworker refused an admit because he had a "newly extubated pt" (he was stable and had been since extubation about 14 hours prior) so whatever. I was a bit annoyed, but said nothing and took it. Then he got bored, I guess, and I see him scrolling down a progress note that belongs to one of my patients.

I'm pretty sure this isn't right so I asked him if he needed anything or wanted to take the patient. He was clueless at my passive aggressive play:inlove: and said he didn't want the pt, but kept on browsing the chart. I asked him to get out of it, please, and he did, but has continued to do it this whole contract so far (except tonight). This is only one incident and it's not just him, but I've never thought of going through someone's chart just because I can. If I'm not breaking someone and giving meds or helping with an admit, I don't see what's so hard about minding my own business.

This was a bit of a vent, but I thought that was a HIPPA violation as the nurses didn't have anything to do with the patient care of my patients at those times. I was thinking of reporting it or at least telling the manager (on my last day lol), but I want to make sure I'm not going overboard. I've never had to even think about this before cause it was always legitimate, either I was in someone else's chart because I was passing meds or vice versa.

Now, this place is SUPER slow (not a real ICU...I've only ever seen 2 vents since I got here and they weren't mine lol) so I get the boredom, but I didn't think it was ok for people do to this. Watch YouTube videos or practice your British accent, or troll Allnurses.com, just stay out of my charts!!

xo

[Maevish, ASN, RN]

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.

Exactly. I would understand if they had a policy for that or that was something known to have happen to double check each other, but this unit doesn't have that. I've worked in places where there were peer audits and either someone would come in on their off day and do it (we took turns) or we'd have a situation like you described.

xo

[jadelpn, LPN, EMT-B]

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

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

We have a very specific rule we have to follow. And that is that when we so much as get up to stretch from the computer, we need to hit the lock key (which on our system is a little padlock icon)

If someone else wants to use the computer, we save and log off.

Under your user name and log on, people are looking at all sorts of things. And you have no way of proving that you did not, and it was someone else. Because it is done on your log in.

Best rule of thumb--yes it is a pain in the butt to keep on hitting the lock key. But you need to--there are nurses who will do just about anything under someone else's log in as to not have it traced to them. If the nurse in question wants to log in himself, then look through files, it is on him. AND can be proved, as he is doing this under his own log in.

Currently, you can say that he is looking through your charts, but then you will be just as "guilty" as you gave him access to same.

Don't ever leave your computer unlocked and unattended.

[jdub6]

You will not get into trouble for someone else being in your chart, that is all on them. As far as reporting it etc, maybe I would tell them to stay out, but not report because you will be leaving soon anyway and you won't be able to change the culture of a unit during your 3 month stay. I used to do travel nursing and the charge nurses and other nurses were often in my charts to make sure I was charting per their norm. Did I like it, no, but I really didn't care because I chart pretty good. Have never been told my charting wasn't right.

When i was the senior staffperson on a small unit working with new or agency nurses i would often skin all the charts, just to make sure nothing is missed by someone who might not know all our policies, that documentation is okay etc. We would also collaborate with each other many times on different patient issues.

I think the key here is its a small unit. That nurse may not have your pt today but likely will at some point or at least be asked to help. I have no idea what his motives are but with a small unit and small team sometimes all pts are kind of everyone's pts.

[NurseMegP, BSN, RN]

Best rule of thumb--yes it is a pain in the butt to keep on hitting the lock key. But you need to--there are nurses who will do just about anything under someone else's log in as to not have it traced to them. If the nurse in question wants to log in himself, then look through files, it is on him. AND can be proved, as he is doing this under his own log in.

Currently, you can say that he is looking through your charts, but then you will be just as "guilty" as you gave him access to same.

Don't ever leave your computer unlocked and unattended.

OP never said she was leaving her log in open. I'm pretty sure he is signing in under his own login and chart surfing.

This is a horrible and ILLEGAL practice. This violates HIPAA. Just google it. I would take this issue to higher than nurse manager as another PP said, the manager will likely cover it up. Not good practice at all. Hope you keep us informed over how this plays out.

[cayenne06, MSN, CNM]

I am sure I am not the only one who thinks HIPAA, while obviously a good idea in theory, is full of frustrating red tape that does little to actually protect patient privacy. HIPAA wasn't really designed with an eye towards health care providers and the reality of providing health care. I am not sure that it is a bad thing for all the nurses in a small, critical unit to be familiar with the patients on the floor. I am not getting the impression that this is what your coworkers are doing, though.

However. It is, indeed, 100% illegal. It is also roundly unethical to view a patient's private data without a solid reason to do so, legalities aside. I also agree a million percent that you need to be sure to lock your screen so no one is browsing under your name- you can't get in trouble for other people breaking HIPAA, but you can be in serious hot water for not protecting your login information. That is as much a HIPAA breach as the situation you describe with your coworkers.

[Zelda, RN]

I'm torn on this. While the coworker obviously wasn't in the chart for a legitimate reason, I do think it is important for him to know the patient and the plan of care.

My unit is separated into pods of 6-7 rooms. There are 2-3 nurses/pod if we're full. I still make it a point to know every patient on my pod. If they're new, I'll probably read their H&P so I know what's going on. In one night, I was in 6/7 patient's rooms - giving PRN meds, helping change them, checking on them when the monitors go off, etc. I need to know why pts are here, so I can help care for them. It also makes you look pretty incompetent if you run into a pts room with no idea of what you're looking for or what their baseline is. I'd never look at a PICU pts chart, though, or a pt on another unit. I wouldn't even look at a patient on another pod.

[canigraduate]

Let me say it one more time.

The law states that you can be in a chart if you need to to complete your job duties.

If you have no job duties that require you to be in the chart, then that is illegal and punishable by law.

Acceptable: audits, looking up info for patient care, looking up a possible patient, house sup checking census, charge nurse looking up stuff to help.

Unacceptable: looking in every patient's chart on your unit as a floor nurse when there is no reasonable expectation that you will be providing some sort of care, surfing through the chart of someone who is not your patient when you have not been asked by the primary nurse to do so, going into a chart of a patient that is not your own to answer questions for visitors who have not been authorized to know anything about the patient, etc.

HIPAA is very specific.

[aeris99]

I still make it a point to know every patient on my pod. If they're new, I'll probably read their H&P so I know what's going on.

I need to know why pts are here, so I can help care for them.

I can see knowing the basics about who's on the floor. That's what the unit huddle (or whatever name it has in your facility) is for.

You can't read H&Ps for patients that aren't assigned to your care. That is a blatant breach of privacy and illegal.

[applesxoranges, BSN, RN]

I remember telling a unit secretary today that she needed to leave a note on why she was in a chart because she was trying to help an outside pharmacy by trying to locate what doctor may have written a prescription. I told her that it was important because her name was now logged in as seeing that chart.

[nursejoy1, ASN, RN]

This is definitely a HIPAA violation. A few years ago, I read an article about an MD in California who simply read some notes on patients that were not his. Did nothing with the info, was simply noticed on a routine audit of electronic records and who had viewed them. This doctor went to prison for four years. One year for each patient's chart he reviewed.

[Anna Flaxis, BSN, RN]

Unacceptable: looking in every patient's chart on your unit as a floor nurse when there is no reasonable expectation that you will be providing some sort of care...

I think this is the crux of the issue. In some small units, there is a reasonable expectation that you will provide care for any/all of the patients in your unit. For instance, in my ER, we provide care for one another's patients routinely, either because the primary RN is in another room, on a break, tied up on the phone coordinating a transfer, or any number of reasons- and we don't have a Charge, because we are so small. When a physician needs something done right this minute, and the primary RN is unavailable, whoever is available jumps in and provides the needed care. Whenever administering a medication or providing an intervention, understanding the rationale and any unique patient characteristics (i.e. whether the patient is opiate naive or on long term opioid therapy, whether the patient is unsteady on their feet at baseline, whether the patient has residual deficits from a previous CVA, etc) is pretty important, in my opinion as a professional ER RN.

I've caught some medication errors before they happened, because the physician placed an order on the wrong patient (easy to do with Epic, if the physician has the wrong window open, is in a hurry, and does not double check), caught only because the order didn't make sense for that particular patient. Had I not known anything about that patient, the medication would have been administered.

So, the question is whether this is the case in the original post- that RNs frequently provide care for one another's patients, and so knowing some basics about every patient in the unit is essential. It doesn't sound like this is the case, which I agree would make accessing the charts inappropriate.

I still think it would behoove the original poster to ask the other RN why they are accessing charts for patients that are not under their care. Is it possible that there was an event in the past, such as a Code Blue that went bad, and this RN thinks it's important to keep tabs on all of the patients for safety purposes?

[Ruby Vee, BSN]

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.

I agree with this!

Looking at other charts is certainly kosher if you're doing chart audits, doing a quality review study based on, for example, documentation of central line dressings or if you're charge. With only two people on shift and you a Traveler, I'd suspect the other employee was charge and was making sure he knew what was going on with your patient. He may also have been tasked with keeping an eye on the Traveler to make sure you were charting according to that unit's policies, or to ensure that things were going smoothly with your assignment or because there is concern that you don't know what you're doing. He may have gotten out of your chart when you told him to because he didn't want a confrontation.

If the other employee were going through charts of patients on another unit, that would be a HIPAA violation, but keeping up with patients on your own unit not so much.