The nurses on my stroke rehab unit have been told that we must give end-of-shift report in the patients’ rooms, most of which are doubles. At 3:30 in the afternoon, many patients have visitors. We’ve been told to pull the curtain between beds and ask visitors to leave while we give report. What is permitted to be verbally reported in this manner under HIPAA rules?
Dear Nancy replies:
As you know, the Health Insurance Portability and Accountability Act’s privacy rule requires that personal health information not be shared with others except in certain circumstances. Due to the nature of nursing practice, if adhered to without fail, the rule would make the sharing of needed patient care information next to impossible.
As a result, the rule does allow for the exchange of information to take place with those who need to hear it (e.g., staff) even in areas where others may hear the information as long as there are reasonable measures taken to keep the information private. Sound professional judgment must be exercised if there is PHI so sensitive that it should not be communicated where others may hear it.
Clearly, your end-of-shift communications are not a violation of the rule. Doing hand offs at the bedside are becoming more and more common, as it allows all nursing staff involved in the report to see the patient and evaluate patient care treatment at the same time. Your practice of asking visitors to leave and pulling the curtain between the beds are reasonable measures other nursing staff have used to protect a patient’s privacy.
Other measures you might want to consider include asking the patient if he minds having the family or visitors in the room. If the patient consents, there is no HIPAA violation. The same measure can take place with the roommate as well. Tell the patient you need to do the end-of-shift report and is it all right if the curtain is pulled and you speak in a low voice with the other patient in the room. Again, if the patient agrees, there is no HIPAA violation.
In an attempt to ensure patient privacy during hand offs at the bedside, many units also prohibit visiting hours during that time. Although somewhat inconvenient for family and visitors, it secures the patient’s privacy from being breached if there are no visitors then.
You can read more about HIPAA’s privacy rule by going to (www.hhs.gov/ocr/privacy/hipaa/understanding/index.html) “Understanding Health Information Privacy. Scroll down the page and click on “For Covered Entities and Business Associates” for valuable information about the rule.