Using HIPPA to get a private room

[33-weeker]

on our birthing unit, we have seen a trend of mothers using hipaa guidelines to get a private room.

medicaid and un-insured drop-ins usually get put in semi-private rooms, unless there are only privates left. but many of these ladies have figured out that if they say they are a 'no info' patient, that they will be put in a private room. we are seeing more and more of it.

the vast majority of them do not have a situation (hiv+, restraining order against s.o., etc...) to be no-info. so far, they seem to have us over a barrel. word has gotten up to our director's boss, but not much has changed.

i wish we could make them show proof of a legitimate reason to be no-info before having to grant this to them.

has anyone else noticed this trend?

[suzanne4, RN]

A NO-Info patient should not necessarily require a private room..........HIPAA protocal should be followed at all times, even if there are four to a room.

[33-weeker]

a no-info patient should not necessarily require a private room..........hipaa protocal should be followed at all times, even if there are four to a room.

true. but i could see how, for example, in the case of an hiv+ mother it would be difficult to discuss those issues without roommate(s) and their visitors overhearing.

[BabyRN2Be]

I had a friend several years ago who had a baby, and she had a restraining order against her ex-husband. It didn't matter to the hospital, they gave her a semi-private and put her next to the window and she just pulled the curtain.

I realize that this was a LONG time before the days of HIPAA.

I wish I had known this trick with my last hospitalization. The little old lady next to me sat on the edge of her bed listening while the nurse was my history. She even asked her to repeat something because she didn't hear it, that's when I put my foot down and just said to the nurse, "I have no idea how these semi-privates are HIPAA compliant." She gave me a sympathetic nod, pulled the curtain and lowered her voice when asking the other questions.

[Mermaid4]

I have a problem with people who are "no info" patients, or those who have "this patient's file is confidential", tagged on ONLY because I thought with the new guidelines, EVERYones' records are confidential...

[33-weeker]

i have a problem with people who are "no info" patients, or those who have "this patient's file is confidential", tagged on only because i thought with the new guidelines, everyones' records are confidential...

that's true, with hipaa (sp! :) ) everyone's stuff is confidential.

however, in our hospital some things are different - like if a visitor is asking about the patient, when we look them up they have 'no info' status, we have to say we have no patient by that name here, as opposed to directing them to that room. i think this goes for transfered calls as well. the pt. must give out her own phone # to their room themselves. if the patient doesn't tell their family/friends where they are, they aren't to know the pt. is even admitted.

[RainDreamer, BSN, RN]

true. but i could see how, for example, in the case of an hiv+ mother it would be difficult to discuss those issues without roommate(s) and their visitors overhearing.

exactly.

when i worked at the county hospital we had 4 moms to a room. i just thought it was interesting how they're all big into patient privacy now with all the hipaa stuff, yet not all hospitals have private rooms for everyone. well, one thing was for dang sure ..... when the docs came in to talk to the patient, everyone in that room could have very well heard what was being said if they had wanted to. so much for total privacy huh?

[SmilingBluEyes]

Oh I can say something to this...I had a pregnancy loss 2 years ago, and there was so much of my history overheard by my roommate and her husband, they both told me they were sorry for my multiple losses after the staff were done settling me into my semi-private bed. It was nice of these folks to care, but it certainly was none of their business. Nor was it mine that the lady had had a hyst due to cancer, was it? But I knew....

There is no way you can not violate HIPAA in a semi-private room. It's impossible unless you can make the patient and her family next to you leave everytime someone comes in to discuss your medical condition with you.

PS there are no "special" cases, the way I read HIPAA. We all are supposed to be entitled to the SAME level of privacy regarding our medical information/condition....at least that is how I read it. I wonder how hospitals with semis and quads can claim they are HIPAA-compliant and not be lying about it.

[emllpn2006]

At my local hospital where I did clinicals they did not put conf patients in private rooms. Instead they got to pick a alias. When a nurse went into the room to give meds or do something with the baby the alias was always used and no one ever mentioned the real name. Most of the time no one but the business office even knew the patients real name becouse the alias was used in place of the real name on all the charting and everything else.

[Justhere, BSN, RN]

I looked into this when I was a student because I was wanting to write a paper how semi-private rooms were all against HIPPA rules. Found this on the HIPAA web site

Question Can health care providers engage in confidential conversations with other providers or with patients, even if there is a possibility that they could be overheard? Answer Yes. The HIPAA Privacy Rule is not intended to prohibit providers from talking to each other and to their patients. Provisions of this Rule requiring covered entities to implement reasonable safeguards that reflect their particular circumstances and exempting treatment disclosures from certain requirements are intended to ensure that providers’ primary consideration is the appropriate treatment of their patients. The Privacy Rule recognizes that oral communications often must occur freely and quickly in treatment settings. Thus, covered entities are free to engage in communications as required for quick, effective, and high quality health care. The Privacy Rule also recognizes that overheard communications in these settings may be unavoidable and allows for these incidental disclosures.

For example, the following practices are permissible under the Privacy Rule, if reasonable precautions are taken to minimize the chance of incidental disclosures to others who may be nearby:

- Health care staff may orally coordinate services at hospital nursing stations.

- Nurses or other health care professionals may discuss a patient’s condition over the phone with the patient, a provider, or a family member.

- A health care professional may discuss lab test results with a patient or other provider in a joint treatment area.

- A physician may discuss a patients’ condition or treatment regimen in the patient’s semi-private room.

- Health care professionals may discuss a patient’s condition during training rounds in an academic or training institution.

- A pharmacist may discuss a prescription with a patient over the pharmacy counter, or with a physician or the patient over the phone.

In these circumstances, reasonable precautions could include using lowered voices or talking apart from others when sharing protected health information. However, in an emergency situation, in a loud emergency room, or where a patient is hearing impaired, such precautions may not be practicable. Covered entities are free to engage in communications as required for quick, effective, and high quality health care.

[SmilingBluEyes]

All fine and good til you are the person whose privacy was breached in a semi private room. Esp if you are a nurse and a good number of staff know who you are, yet you don't necessarily want them to know your situation.

When pressed, I bet staff COULD get in trouble over HIPAA violations in non-private room situations. Unless you can control who enters or leaves, you may have no real idea what ears are taking in your information and what may be done with it. Yes, these things can be discussed in the semi private room, but this does not address controlling who is there to hear the information being discussed. This is where we CAN get into trouble, if not careful.

[MemphisOBRNC, BSN, RN]

Penny is right. Incidental disclosure is covered by HIPPA. One option is to put your routine admission questions into layman's terms and have them fill it out. Our computer screen can be turned so the patient can see them and oftentimes, I will let them look at the screen that covers STD's etc. and ask them if they have had any of them. If they answer yes, I ask which, the first, second, third....

This question is in general: When you have patients arrive, do you ask the family/ support person to wait in the waiting room until the admission questions have been asked?