What are CNA's allowed to know? (HIPAA question)

[Donnagg123]

Okay, I am curious if I am right or are other co-workers right.

Are CNA's allowed to look in charts?

I question this for two situations - one was a CNA who went to look in her grandmothers chart for information (curiosity reasons) and when I told her not to she got very upset. I told her it was a HIPAA violation. She (weeks later) told me that where she used to work the CNA's used to get in charts all the time and a nurse who works with us backed her up. They stated maybe it is a facility thing but I said HIPAA is federal and CNA's are not allowed in charts. We also got into an argument about what I should tell the CNA (like if a person had AIDS, etc) and I said technically that is a HIPAA violation. And she stated that she should have a right to know because they (CNAs) are the "primary caregivers", and I said HIPAA would say if you use universal precautions that should cover everyone no matter what a resident has. and if there was anything that didn't I would tell her what equipment to use.

Another situation was a similar one, a CNA was looking in residents chart on behalf of another worker (it was her friends aunt). And she also got mad and stated I had never said anything before and I told her that was because I had never saw her do it.

My point is that I think that CNA's should not be in charts. There is nothing in there that they need to know and if they do it should come from the nurses (me). Other people, even nurses, disagree. I feel like if they are caught doing it on "my watch" then I would be the one in trouble, and I feel it is my job to vigorously protect patients info as I would my own. I know they are not allowed to look in charts of relatives or curiosity reasons for sure, but what is the law when it comes to HIPAA and CNA's?

[Virgo_RN, BSN, RN]

The two examples in the OP are definitely violations of HIPAA.

At my facility, we have hard charts and electronic records. The electronic record has a CNA worklist, which is where the CNAs can go to find out what kind of diet the patient is on, whether they need to be ambulated or are on bedrest, if they are turn Q2, how often vitals are to be done, etc. CNAs do not have access to the patient's med list, labs, H&P, or imaging results, and there is no need for CNAs to look at the hard chart in order to do their job, therefore, it would be a HIPAA violation for them to do so.

[SharonH, RN]

are CNA's from a HIPAA standpoint allowed to look in residents charts?

Yes, they are.

I don't understand why you're even going there with the question. I've never heard of anyone else ever questioning it. People really make HIPAA too complicated. I am sure that the intention to protect patients' privacy was never to distinguish between levels of direct care providers and police exactly what this person and that person needed to know within the health care team needed to know.

Do you have a compliance officer at your facility? You most surely do. Check with them and then get back to us. I'll be surprised if they state that the CNA's couldn't look at the chart but I could be wrong. It's their job to know and I can learn something.

[Pipsqueak, ADN]

Obviously, the scenario in the OP is a HIPAA violation for all the reasons already stated.

Now, if you're asking if CNA's in general are allowed to access the chart(for work related purposes), you might be better off checking your facility policy as this is something that seems to vary within facilities.

[SHELLYLEE-RN]

:nurse:Does anyone know if aides are allowed to read pt. charts? At one place where I worked they were absolutely not allowed; however, at my present place of employment our DON and ADMINISTRATOR said that they have no problem with the aides reading the charts.

[pagandeva2000, LPN]

I guess it depends on the facility. Personally, I don't have an issue with aides reading a chart. They are doing direct care and can be affected by some things, in addition, it can be a great learning tool for them. If your facility has no issues with it, and the aides are not violating HIPPA compliance by telling others, I don't see an issue.

[sirI, MSN, APRN, NP]

Threads merged.

[MIcrunchyRN]

First off looking in a chart that is a family member or friend of a family member period is a hippa violation unless you need to know that specific info. Even me looking in my husbands chart is a hippa violation unless I"m his DPOA.

She could have been looking in chart for I&Os or something and that IS legal but looking for curiosity reasons even if you are caring for patient is a grey area. If they went in looking for soemthing specific then it would be ok, just for curiosity screams a violation IMO.

You did the right thing next time report them especially when they are looking thru friends/family members charts.

[lpnflorida]

I agree with others who have stated it was a HIPPA violation to look at the chart of someone in who's care you are not directly involved in.

Let me give an example of what occured once. A male entered our nursing station. Stated he was dr so and so. Scanned our rack took out a chart, then proceeded with it to the doctors dictation room. It quickly came to our attention that this in fact was not a doctor involved in this patients care , but a relative. I walked calmly into that room. Respectfully reminded the DR that he was not allowed to look at the chart as he was not on consult, he gave me back the chart. I smiled and calmly walked out of the room. I did let our supervisor and DON know what had occurred and how it was handled. Enough said.

[missjennmb]

I don't think that example is anywhere close to looking at a patient's chart who you are caring for. I think that, in order to provide complete care, given the assumption that we are all under the understanding of HIPPA and patient privacy, its silly not to allow aides to see whats going on. If they were wandering off w/ charts or some crazy thing like that it would be an issue, but how is it not beneficial to the client if the person caring for him knows that he just got bad news and needs a little extra TLC in his care? If we're JUST doing physical work thats one thing, but this kinda feeds into the philosophy of caring for the whole person doesn't it?

[lpnflorida]

Warning: This is long ( taken from HIPPA site) appears to be the individual facilites who decides what their employees have informational access to regarding patient information.

(A) Authorization and/or supervision (Addressable). Implement procedures for the authorization and/or supervision of workforce members who work with electronic protected health information or in locations where it might be accessed.

(B)

Access authorization (Addressable). Implement policies and procedures for granting access to electronic protected health information, for example, through access to a workstation, transaction, program, process, or other mechanism.

©

Access establishment and modification (Addressable). Implement policies and procedures that, based upon the entity's access authorization policies, establish, document, review, and modify a user's right of access to a workstation, transaction, program, or process.

(5)(i) Standard: Security awareness and training. Implement a security awareness and training program for all members of its workforce (including management).

(ii) Implementation specifications. Implement:

(A)

Security reminders (Addressable). Periodic security updates.

(B)

Protection from malicious software (Addressable). Procedures for guarding against, detecting, and reporting malicious software.

©

Log-in monitoring (Addressable). Procedures for monitoring log-in attempts and reporting discrepancies.

(D)

Password management (Addressable). Procedures for creating, changing, and safeguarding passwords.

(6)(i) Standard: Security incident procedures.

-

[abbaking]

Okay, I am curious if I am right or are other co-workers right.

Are CNA's allowed to look in charts?

I question this for two situations - one was a CNA who went to look in her grandmothers chart for information (curiosity reasons) and when I told her not to she got very upset. I told her it was a HIPAA violation. She (weeks later) told me that where she used to work the CNA's used to get in charts all the time and a nurse who works with us backed her up. They stated maybe it is a facility thing but I said HIPAA is federal and CNA's are not allowed in charts. We also got into an argument about what I should tell the CNA (like if a person had AIDS, etc) and I said technically that is a HIPAA violation. And she stated that she should have a right to know because they (CNAs) are the "primary caregivers", and I said HIPAA would say if you use universal precautions that should cover everyone no matter what a resident has. and if there was anything that didn't I would tell her what equipment to use.

Another situation was a similar one, a CNA was looking in residents chart on behalf of another worker (it was her friends aunt). And she also got mad and stated I had never said anything before and I told her that was because I had never saw her do it.

My point is that I think that CNA's should not be in charts. There is nothing in there that they need to know and if they do it should come from the nurses (me). Other people, even nurses, disagree. I feel like if they are caught doing it on "my watch" then I would be the one in trouble, and I feel it is my job to vigorously protect patients info as I would my own. I know they are not allowed to look in charts of relatives or curiosity reasons for sure, but what is the law when it comes to HIPAA and CNA's?

In this situation - NO!!! Both of the above situations are HIPAA violations and the CNA has no right or need to know. HIPAA violations are SERIOUS crimes punishable with fines up to $25,000 or 10 years of jail time....tough stuff!

When it come to assisting with the plan of care or inquiring on a patients condition the CNA is caring for, reading the chart is fine and, in some facilities, encouraged. Whenever I work with the CNA's and they has concerns or questions about the plan of care or nursing interventions, I refer them to the patient chart so that they can betrter understand how to give the best possible care. There is nothing more dangerous than giving patient care blindly or not being fully informed of a patient condition, hx, emotional status, etc.