In order to explain how the Health Insurance Portability and Accountability Act are affecting nursing care today, the act itself must be defined. HIPAA is one of the most important acts that have been passed to protect patients’ privacy and give them security. HIPAA privacy standards include some of the most restrictive guidelines in regards to accessing identifiable health information and disclosures. The guidelines were set into place to protect the patient from having their information disclosed verbally, written or by electronic transfer (Pozgar, 2012). The Privacy rule is clearly defined as “HIPAA”, which ensures the privacy and protection of all health information. Before HIPAA many states had their own standards and guidelines for healthcare privacy and practice (ANA, 2014).
HIPAA has given us unison and uniformity as a healthcare nation, not just a state. The standards and guidelines protecting the privacy of an individual’s health information were issued by the United States Department of Health and Human Services (HIPAA 101, 2014). The privacy rule, does allow the use of healthcare information to promote the best quality of health care. The rule also protects the confidentiality of the patient. HIPAA also affects the patient’s own access to their medical records. The individual is often asked to sign an authorization request form upon admission. The form consists or should include a description of the information that is going to be used or disclosed to other authorized individuals in a detailed manner. The client should also be given the names of the individual that will have access to their identifiable information. The patient must also be made aware of the fact that he or she has the right to revoke the authorization request at any time.
HIPAA regulations also require that codes be set into place for encoding vital records such as, medical terms and procedure codes (HIPAA 101, 2014). As a nurse working in a hospital setting, I am aware of the requirements to give patients clear, insightful, written information concerning their Patient Rights and the disclosures of their personal information. Patients are asked to sign a permission form giving us permission to share their information with other healthcare workers. The patient’s information is only allowed to be shared with the healthcare providers that have an active role in the client’s care. For example, if a healthcare provider discloses any information about a patient with another person or coworker that has not been authorized by the patient, it is a violation of HIPAA.
The Patient’s Bill of Rights was created by the American Hospital Association in 1973. It was developed to ensure that good viable communication occurs between the patient and the healthcare provider. The Bill of Rights entitles the patient to the right to be involved in every decision about his or her plan of care prior to any treatments and throughout the treatment process. If the patient is competent and has no mental incapacities at their own accord they can refuse treatment at any time. All patients are to be informed of all of their diagnoses, treatments, and the consequences of those treatments. The Patient’s Bill of Rights also gives patients the right to be informed about advance directives. (Pozgar, 2012). There are two common types of advance directives, a living will or a dual power of attorney.
A living will provides outlines about medical treatments. It will have details about the patient’s wishes or their refusal of a treatment if they become incapacitated. A dual power of attorney for healthcare designates a person or persons appointed by the client to make healthcare decisions if and when the client is unable to. Advance directives are used to provide guidance to nurses and other members of the healthcare team. A copy of the advance directive must be placed in the client’s medical chart. The physician is notified of the advance directive so that his or her written orders do not coincide with the client’s wishes. When disclosing patient information it should be done in a private location away from other staff members and patients. The only time that information about a patient may not be kept confidential. Is when the cases involve abuse or a public health hazard (Hogan, 2012). Violating the HIPAA guidelines and rules can Intel extensive consequences, for the healthcare provider, nurse, and the healthcare facility.
The consequences may include termination, suspension, law suits, and huge fines for hospital and employee (ANA, 2014). The most resourceful and reliable information can be given by the client or a family member. In order for the most accurate information to be retrieved there must be trust and respect between the healthcare provider and the patient. Violating HIPAA and its codes could damage or destroy the trust between physicians or nurses and the client. If the patient does not provide the physician or nurse with the concise and accurate information about their past and present health, the outcome could be detrimental for the hospital and the patient. For example, if a patient has to have surgery and the anesthesiologist is using demoral to sedate the client. The client fails to tell the doctor that he or she is allergic to demoral. The patient experiences anaphylactic shock which is a severe allergic reaction that can cut off the airway completely. Recovery for the patient may or may not be feasible. Good communication between the client and the healthcare providers is needed to sustain life and to save lives. Clients need the security that goes along with HIPAA.
They need to feel secure in the fact that whatever they tell their healthcare provider is secure and confidential. An incident occurred one day as I was working in the emergency room area. A patient came in suffering from severe chest pains and I was designated to interview the client and retrieve vital information. All of the routine questions were asked and answered. The last and final question that I approached the client with was his current intake of medication preferably Viagra. I remember him giving me this look as if he did not understand the words that had just escaped my mouth. Taking into consideration that his spouse was present and that she may not be aware of his enhancement drug, she was directed to the lounge for coffee. I asked the client once again “Mr. J have you or are you currently taking Viagra”. He answered “No I am only 45 I have no need for Viagra”.
My nursing instincts kicked in and his aggressive answers and body language made me feel as if he was not being completely honest with me. At that moment I decided to explain my reasoning for this line of questioning and the importance of the situation. I informed Mr. J that he was being administered Nitroglycerin to help with his angina. Angina is chest pain. Nitroglycerin and Viagra when given together can be a deadly combination because they both contain Nitro which dilates your blood vessels. When combined together these two medications can lower your blood pressure to the point that death may occur. I know what you are thinking what an awful thing to say, but for some patients the truth in a upfront and nondisclosure way works best. Mr. J admitted to using Viagra and precautions were taking to sustain his life. Within 48 hours he was released from the hospital.
This scenario was meant to show the importance of patient and healthcare provider information. It is very important that a rapport is made between the client and you. I think that violating HIPAA cripples our chance of building and maintaining a bond with the patients. Another example of a way that HIPAA can be violated is disclosing information to neighbors and friend that have not been authorized. Home Healthcare workers are faced with this dilemma frequently. This scenario refers to a nurse that visits her client twice a week. The client has taken ill and is unable to venture out into her yard to work in her garden. The neighbors become worried because Mrs. X is known for being in her garden daily. One day as the nurse was leaving Mrs. X house she is approached by her neighbor Mrs. B. Mrs. B asked “how is Mrs. X doing these days?’ The best response by the nurse would be not to disclose any of Mrs. X information although Mrs. B is just being a concerned neighbor. The nurse replied “disclosing any information about Mrs. X is a violation of HIPAA and for that reason I am not inclined to answer your question”.
HIPAA has strict guidelines that we are to follow even when we are out of the hospital setting. .Healthcare workers have always had some sort of privacy guidelines in place to protect the patient’s privacy. Nurses have always and still are front runners when it comes to maintaining HIPAA and its guidelines. The American Nursing Association has a Code of Ethics that contain statements and requirements that instruct nurses to keep patients information private. Hospitals have implemented different strategies and techniques to ensure that HIPAA is not being violated. In the facility where I work there are strict rules and regulations about disclosing patient information over the phone. The Golden Rule is do not do it. The reason behind this rule is because you never really know who is on the other end of the line. Disclosing health information in this manner can certainly be in violation of HIPAA. Almost all of the charting that nurses do is done on a computerized system.
We must sign in and out each time with our assigned user ID and passcode. It is recommended that the password that we choose is difficult to figure out and to change the passcode often. Nurses should never give or share their passcodes with other coworkers. Hospitals are constantly developing ways to increase their security to ensure that a patient’s medical record is deemed private and remain private. Encryption technology and software is a great place to start. Computers and laptops, over the years have disappeared from different hospitals. These computers often contain vital patient records. Encryption will allow the hospitals IT management team to ease the minds of concerned individuals by acknowledging that their information is encrypted and not easily accessible. Some hospitals purchase self-encrypted hard drives because they have been known to provide stronger protection (Fields, 2012). The patient’s chart and any other paperwork that contain their personal information is always place faced down so that it is not viewable by individuals passing by. Another security measure to protect patient privacy is the names on the room door that is no longer permissible.
Nurses are required to use two patient identifiers to ensure that the right patient is given the correct medication and before any procedures are done (Hogan, 2012). If a family member or an unknown individual calls the front desk and asks “is Jim Jones in the hospital and what room is he in”. Nurses are inclined to respond by saying “we do not have a Jim Jones. I know it sounds like a little white lie to most, but our first priority is always to our patients. Later, that same individual can call back and say can you connect me to Mr. Jim Jones in room 204 and they will be connected. HIPAA has strict guidelines and as healthcare providers we are required to follow at all times. Nurses are on the frontline when it comes to patient care and privacy. Nurses are advocates for their patients and act and speak for them when they are unable to (Pozgar, 2012). Nurses work with patients and their families every hour of every day.
Nurses knowledge and understanding of HIPAA is important not only for the patient, but for the facilities that we are working in. To violate HIPAA and its guidelines is to violate our ethics and our patient’s moral beliefs and trust that they have bestowed upon us. HIPAA is more about nurses and other healthcare providers changing the way they think and act in reference to patients’ privacy and security. Some may think that improving technology and upgrading their computer software is the ultimate game changer. I believe as nurses, we have a duty to self, job, and patient. Nurses must become innovative when it comes to discussing a patient’s personal health information. The facility that you currently work in are probably not willing or able to sound proof every room.
Therefore, maybe changing the way we speak or the tone of our voice when discussing sensitive identifiable patient information. It is important to never discuss a client’s health information in a hallway, stairwell, elevator, or outside the facility. When possible try to find a secluded area or room and close the door. These are small and simple adjustments that can make a big impact. Being mindful of the environment that you work in is necessary in order to plan and establish privacy measures for the clients. HIPAA is not in place to define nursing care, but to enhance patient care and trust, to encourage nurses and other healthcare workers to make an effort, to take the initiative, to preserve privacy and integrity of the patients that we serve.
Fields, Rachel. (2012, November, 9) “Protecting Patient Data to Protect Your Hospital retrieved February 12, 2014 from http://www.beckershospitalreview.com “HIPAA: Health Insurance Portability and Accountability Act” (2014) AMA.assn.org. Retrieved February 22, 2014 from http://www.ama.assn.org “HIPAA: Privacy Rule and Compliance (2014, February, 26) hipaa101.com Retrieved February 12, 2014 from http://www.hipaa101.com Hogan, Maryann. (2012) Comprehensive Review for the NCLEX- RN (2nd Edition pp, 25 & 272-274) Pearson Education Inc. Pozgar, D. George. (2012) Legal Aspects of Healthcare Administration (11th edition pp,282-284 and 336-343) Jones & Bartlett Learning