Week 4 Lecture Confidentiality, information security Continuity of care Establishing Priorities

Question 1

What does HIPAA stand for

Answer 1

Health insurance portability and accountability act

Question 2

How does HIPAA protect clients?

Answer 2

For individually identifiable health information

Gives patients rights in respect to that information

Permits disclosure of health information needed for client care

Permits disclosure of health information for insurance reimbursement

Permits disclosure of health information for quality improvement activities

Client must consent in writing to have identifiable for medical information shared outsite of the above

Question 3

Privacy Rule

Answer 3

falls under HIPAA, protects all oral, written and electronic

→ ´Name, date of birth, SSN, health information (past, present, future), demographic information (address, phone number, email), billing & payment information, information about relatives, household members and employers

Question 4

How does HIPAA legally limit access to medical records to those on a need to know basis

Answer 4

Direct need to know: Nurse, UAP, Dietitian, student nurse

Indirect need to know: Unit Manager, infection control nurse, health insurance company

Question 5

What is health information that is to remain confidential?

Answer 5

Client’s chart/medical record
Conversations about client’s care/treatment
Billing information
Information in organizations computer system

Question 6

How can nurses maintain client confidentiality?

Answer 6

Never discuss with those who do not have a need to know
Protect and secure written records
Log off after every entry
Never share your password
Don’t share information via phone or email unless secrete code is provided
Social media and cell phones STRICTLY PROHIBITED
Adhere to organizations regulations, policies and procedures
Dispose of protected information in confidential bin, shredding

Question 7

Written permission

Answer 7

required for provider to give information to an employe

Question 8

When is it acceptable to share information without the clients permission?

Answer 8

Can share to coordinate care with other team members

Medical emergency

Shared for payment, quality assessment, legal issues, auditing, training, evaluating performance or providers

May release information to relative or significant other if client can’t approve due to illness or injury

Question 9

Describe the confidentiality that comes with photographing clients?

Answer 9

Permission is needed when name, face, or unique feature shown

Permission is not needed is taken as part of a client’s medical record or when it does not show enough information to ID client

Photographs are protected health information
– Same protection for written information apply to photos

Question 10

Minor privacy

Answer 10

Minors have a right to privacy but most situations legal guardian or parent is authorized to receive and release minors protected health information

Question 11

Minor privacy: suspision of parental abuse

Answer 11

Is suspicion of parental abuse, neglect or endangerment then parents cannot control minors information

Question 12

Parents and minor confidentiality - they can agree to what?

Answer 12

Parent can agree to a confidential relationship between provider and minor

Question 13

Can parent and caregiver discuss minors health information without permission?

Answer 13

Not appropriate to discuss client’s information with caregiver without client’s permission

Question 14

What are examples of emancipated minors?

Answer 14

Emancipated minor - marriage, pregnancy, armed forces, court order

Question 15

What should the nurse do if she observes action to neonate?

Answer 15

neonates safety and protection becomes first priority

Question 16

Deidentified health information

Answer 16

No limits on use of deidentified health information, it isn’t protected by the privacy rule

Includes any health information that doesn’t reveal client’s commonly identifiable information

Ex. case study presented at a conference where fictitious name is used

Question 17

How can we assess staff member and client understanding of confidentiality requirements?

Answer 17

Observe staff as they perform their roles to assess if they uphold these rights

Assess their knowledge about HIPAA

Take note of conversations in public areas

Assess is computers are being logged off from or sitting open

Does staff secure written medical records

How does staff respond to questions about clients from visitors

Assess clients for knowledge of rights, assess if staff is evaluation client knowledge about confidentiality

Question 18

How can you intervene appropriately when confidentiality has been breached by staff members

Answer 18

Professional, ethical and legal responsibility of the RN to insure client rights and HIPAA rights are upheld, supported and advocated

If RN witnesses breach of confidentiality – INTERVENE by correcting the situation immediately and don’t allow it to continue. Report chain of command for your organization

Breeches are subject to fines, civil and criminal liability

Question 19

Continuity of care Timely

Answer 19

smooth unfragmented transition of a client during a change in level of care, transfer to a different facility, or discharge to home

Question 20

report should include what

Answer 20

change of shift, transfer or report to provider

critical component of continuity of care

Question 21

how to facilities ensure smooth continuity of care?

Answer 21

Examples of standardized organizational tools for report include - SBAR, ISBAR, BATON, Five P’s, IPASS

Question 22

What components about the client are includes in report?

Answer 22

Client’s name, doctor, date of admission and diagnosis

Any unresolved / uncompleted tasks

Priorities, abnormal results, fluid status (intake and output)

Significant information on status/condition

Client’s response to care/treatment

consults/referrals

Changes in plan of care

Anything unusual or special treatments

Question 23

What is included in the use of documents to record and communicate client information?

Answer 23

Documentation is a form of written communication

Facilities have their own documentation methods and forms

Needs to be complete, accurate and timely

Allows interdisciplinary exchange of information

Provides evidence of legal responsibilities, demonstrates standards

Supplies information for cost-to-benefit reduction analysis

Furnished information for research, continuing education, risk management, reimbursement, quality improvement

Question 24

What can lead to documentation errors?

Answer 24

Omissions of information

Personal opinions (should always be objective or direct statement of client)

vague/abbreviations

Late entries

Improper corrections

Illegibility, lack of clarity

Omission of reasoning for drug administration not completed as ordered
– Must chart why a drug is not administered

Question 25

Describe abbreviation use in documents?

Answer 25

Only accepted and approved abbreviations should be used

All facilities are required to have formalized list of unacceptable abbreviations

• • May be misinterpreted
• • Leads to errors and and confusion

Joint Commision on Accreditation of Healthcare Organizations is a guide for these

Question 26

Continuity of care: perform procedures necessary to safely admit, transfer or discharge a client

Answer 26

Admission and discharge should always be completed by RN

Admission and transfer – client is assessed and plan of care is started by receiving nurse

Admission process includes orienting client and support system to setting, complete review of bio-psycho-social status and needs, med.

Reconciliation, complete assessment, give information on HIPAA, client rights and responsibilities

Sending area of transfer provides a complete report. May have transfer form to complete

Discharges - sender insures discharge is appropriate for client, sharing of information to receiver if applicable

Discharge planning starts before admission for planned admission or at the moment of admission for unplanned admission

Question 27

What should nurse do if there are unresolved issues?

Answer 27

Never leave unresolved

Report unresolved issues following chain of command

Question 28

Team nursing

Answer 28

RN leads staff that care for a specific number of clients

Team = RN, LPN, UAP

Team lead assesses and makes plan of care

Team lead assigns tasks to team as needed

Question 29

Modular nursing

Answer 29

RN is paired with LPN to provide care to small group of clients

Question 30

Primary nursing

Answer 30

RN plans and organizes care for group of client entire hospitalization

RN assumes 24 hour accountability and delegates care in their absence

Nurse delegated to is called associate nurse

Question 31

Total client care nursing

Answer 31

RN plans, organized, delivers care for a specific group of clients

Question 32

Functional nursing

Answer 32

Each caregiver is given specific tasks

Question 33

Establishing priorities

Answer 33

actual problems/needs take priority over wellness or possible risk
→ short term acute needs take priority over long term chronic needs

Question 34

How should a nurse prioritize who she treats first?

Answer 34

ABC’s = airway, breathing and cardiovascular status is the highest priority, IN THAT ORDER

Only exception is during CPR, then CAB

Question 35

How should a nurse prioritize Maslows Hierarchy of needs?

Answer 35

Physiological - ABCs, nutrition, sleep, elimination

safety/psychological/emotional needs - low stress/anxiety, emotion support, comfort

Need for loving and belonging - acceptance of others

Need for self esteem - recognized and respected

Need for self-actualization - motivate to reach highest potential

If a physiological need is not addresses then look for safety

Question 36

How can a nurse apply knowledge when establishing priorities for interventions with multiple clients

Answer 36

utilize the nursing process (asses, analyze, plan, implement, evaluate)

however, in an emergent situation, the action may take priority over doing an assessment (if someone is bleeding out)

Question 37

What do we need to remember when prioritizing care?

Answer 37

everything is important - we need to determine the correct order of action

• • avoid unnecessary interruptions
• • avoid helping other if it can jeopardize your own priorities of care