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Reporting Abuse Patient Confidentiality. Objectives Define HIPAA State the purpose of HIPAA List protected medical information List examples of how patient.

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Presentation on theme: "Reporting Abuse Patient Confidentiality. Objectives Define HIPAA State the purpose of HIPAA List protected medical information List examples of how patient."— Presentation transcript:

1 Reporting Abuse Patient Confidentiality

2 Objectives Define HIPAA State the purpose of HIPAA List protected medical information List examples of how patient confidentiality is protected in daily nursing practice List exceptions to the confidentiality rules List penalties for violations of HIPAA rules Define nurse’s responsibilities regarding suspected cases of abuse


4 HIPAA - What is it? 1996: Congress passed the Health Insurance Portability and Accountability Act The HIPAA provisions were tacked on to a law about health insurance portability - or - Taking your insurance with you to a new job Law was modified and finally released in 2002

5 HIPPA Covers 3 areas: 1. Insurance portability: individuals moving from one health plan to another will have continuity of coverage and will not be denied coverage under pre-existing condition clauses 2. Fraud enforcement (accountability): increases the federal government’s fraud enforcement authority 3. Administrative Simplification: reductions in health care cost

6 HIPAA Purpose: To ensure the individuals right to privacy with regard to their healthcare treatment, condition, and information Requires health care organizations to protect their patients privacy and the confidentiality of protected health information (PHI) Punishes individuals or organizations that fail to keep patient information confidential

7 HIPAA provisions Patients have a right to: See and copy their health record Update their health record Get a list of the disclosures a healthcare institution has made independent of disclosures made for the purposes of treatment, payment, and healthcare operations Request a restriction on certain uses or disclosures Choose how to receive health information

8 HIPAA provisions Patient authorization is required to release information for purposes other than Treatment Payment Routine health operations Patient may revoke authorization at any time

9 Doctrine of Privileged Information States that individuals in a protected relationship, such as a doctor and patient, cannot be forced, even during legal proceedings, to reveal communication between them unless the person who benefits from the protection agrees to it. Examples: MD, psychiatrist, psychologist State laws determine protected relationships Not all state laws privilege nurse-patient relationships

10 Health Information

11 Health Information includes: Names and all identifiers such as address, telephone and fax number, Social Security number and any other personal information The reason the patient is sick or in the hospital, office or clinic The treatments he/she receives Information about past health conditions

12 Health Information includes: Personal information: name, address, employer, date of birth, telephone and fax numbers, social security number, any other characteristics such as occupation that may identify and individual Patient medical records: admission history, graphic sheet information, results of lab work and tests, medications, consultations Computerized information Telephone calls, voice mails, fax transmissions e-mails, conversations about patients between clinical staff

13 Health Information Should be accessed on a “Need to Know” basis only Examples: ?

14 Invasion of Privacy Patients have a legal and moral right to privacy Invasion of this right: Constitutes an “intentional tort” or a willful wrong committed against another person (like assault and battery, defamation of character) Can be a civil or criminal offense

15 Invasion of Privacy - Examples Unnecessary exposure of patients while moving them through a corridor or while caring for them in rooms they share with others Talking with patients in rooms that are not soundproof Discussing patient information with people not entitled to the information (ex: the patient’s employer or the press) Pressing the patient for information not necessary for care planning

16 Invasion of Privacy - Examples Interacting with the patient’s family in ways not authorized by the patient Using tape recorders, dictating machines, computers, and the like without taking precautions to ensure the patient’s confidentiality Preparing written or oral class assignments about patient without concealing their identity Carrying out research without taking proper precautions to ensure the anonymity of patients

17 Invasion of Privacy - Examples Discussing patient information in any public area where those who have no need to know the information can overhear: elevators, lunchroom, public transport Leaving patient medical information in a public area Leaving a computer unattended in an accessible area with the medical record information unsecured or failing to log off a computer Sharing passwords

18 Invasion of Privacy - Examples Improperly accessing, reviewing, and/or releasing the medical record of a patient in the following situations: For use in a personal relationship For the purpose of giving or selling the information to the media Who is a co-worker and is also a patient To bring harm to the organization or individuals associated with it

19 Scenario Patient admits to you that he/she thinks he might be HIV positive. Testing confirms that this is true. Can you:  Discuss this with your co-workers?  Discuss this with the patient’s spouse or any family member  Discuss this in the elevator  Discuss this with the patient’s physician  Discuss this with your nurse manager

20 HIPPO’s Gossiping

21 HIPAA Regulations - How they affect nursing practice Patient census boards: provide only the minimum information necessary Medical records and MAR (medication administration record): Information must be placed face down when it can be visible to the public; not left unattended in public places Nurses should find out from patients which family members can be included in updates about the patient’s condition

22 HIPAA regulations - How they affect nursing practice Voicemail messages: minimal information should be left Sign-in sheets: Minimal information Confidential conversations between nurse and the patient, MD, other healthcare team members involved in this patient’s care: voices should be kept low Information on paper no longer needed (yesterday’s MAR, report record) should be put in shredder bin


24 HIPAA violations May be punishable with civil and criminal penalties Punishments may include monetary penalties as well as imprisonment Criminal penalties for release of health information  Fine of $50,000 and up to 1 year imprisonment  If false pretenses are involved: $100,000 and 5 years imprisonment  Intent to sell or transfer information: $250,000 and up to 10 years imprisonment

25 Permitted Disclosure of PHI Public Health Activities:  Tracking disease outbreaks  Statistics related to dangerous drugs or medical equipment Law enforcement and judicial proceedings  Medical records crucial to criminal investigation and prosecution  Medical records to identify crime victims  Medical records regarding abuse, neglect or domestic violence  Medical records released according to subpoena

26 Permitted Disclosure of PHI Deceased Individuals  PHI needed by coroners, medical examiners, funeral directors  PHI needed to facilitate organ donations  PHI needed to investigate a death involved in a potential crime

27 HIPAA and student nurses How does this affect you as a student nurse? You can access the medical record of the patient to which you are assigned You can copy down information which is necessary to prepare for an assignment (including medications, lab values, progress notes, admission notes) You cannot duplicate any part of the medical record Any information taken from the unit should have the patient’s identifying information obliterated

28 HIPAA and student nurses Do not obliterate the patient’s name on the MAR (medication administration record) Do not discuss patients in the elevator, lunchroom, or any public place Respect patients’ privacy when providing care

29 Reporting Abuse Abuse: 1. Neglect: a situation wherein a basic need of the client is not being provided 2. abuse: an incident involving some type of violation to the client 3. Domestic violence: a pattern of controlling behavior and assaults including physical, sexual and psychological attacks and economic control that some adolescents and adults use against their intimate partners

30 Nursing Responsibilities Responsible for knowing the law, especially about mandatory reporting of domestic violence and abuse National Domestic Violence HOTLINE 1-800-799 -7233 (SAFE)

31 Domestic Abuse Usually is one of the following: Child abuse Abuse of a spouse or domestic intimate partner elder abuse

32 Domestic Abuse Def: when one person in a marital or intimate relationship tries to control the other person. The perpetrator uses fear and intimidation and may threaten to use or may actually use physical violence. Domestic abuse that includes violence is called domestic violence Key elements: intimidation Humiliating the other person physical injury

33 Domestic Abuse - Types Physical violence verbal or nonverbal abuse (psychological abuse, mental abuse, emotional abuse) sexual abuse stalking or cyberstalking economic abuse or financial abuse spiritual abuse

34 Physical Abuse Includes: pushing, throwing, kicking slapping, grabbing, hitting, punching beating, tripping, battering, bruising, choking, shaking pinching, biting holding, restraining, confinement breaking bones assault with a weapon such as a knife or gun burning murder

35 Emotional Abuse Includes: threatening or intimidating destruction of the other person’s personal property yelling or screaming name-calling, belittling, insulting constant criticizing, blaming embarrassing, mocking, humiliating excessive possessiveness, isolation from friends and family

36 Sexual Abuse Includes: sexual assault: forcing someone to participate in unwanted, unsafe or degrading sexual activity sexual harassment sexual exploitation: forcing someone to participate in pornography

37 Financial Abuse Includes: withholding economic resources such as money or credit cards stealing from or defrauding a partner of money or assets exploiting the partner’s resources for personal gain withholding physical resources such as food, clothes, necessary medications, or shelter preventing the partner from working or choosing an occupation

38 Spiritual Abuse Includes: Using spouse’s religious or spiritual beliefs to manipulate them preventing the partner from practicing their religious or spiritual beliefs ridiculing the other person’s religious or spiritual beliefs forcing the children to be reared in a faith that the partner has not agreed to

39 Child Abuse Consists of any act or failure to act that endangers a child’s physical or emotional health and development. A person caring for the child is abusive if he or she fails to nurture the child, physically injures the child, or relates sexually to the child Child abuse HOTLINE 1-800-4-A-CHILD (1-800-422-4453)

40 Child Abuse Types: 1. Physical abuse 2. Sexual Abuse 3. Emotional abuse 4. Neglect 5. Exploitation

41 Physical Abuse Includes: beating, whipping, punching, slapping or hitting pushing, shoving, shaking, kicking or throwing pinching, biting, choking or hair-pulling burning severe, inappropriate physical punishment

42 Sexual Abuse Any sexual act between an adult and a child privacy violations exposing children to pornography exposing a child to adult sexuality

43 Neglect Failure to provide for the child’s basic needs Physical: failure to provide adequate food, clothing, shelter, lack of supervision, abandonment, inadequate hygiene Educational: failure to provide an education Emotional: lack of emotional support and love, domestic violence in the child’s presence, drug or alcohol abuse in the child’s presence

44 Emotional Abuse ignoring, withdrawal of attention or rejection lack of physical affection lack or praise, or positive reinforcement yelling or screaming threatening or frightening belittling, humiliating scapegoating or blaming

45 Symptoms of Child Abuse Physical: unexplained cuts, bruises, burns, bite-marks, anti-social behavior, fear of adults, self-destructive or suicidal behavior Emotional: apathy, depression, hostility, lack of concentration, eating disorders Sexual: inappropriate interest in or knowledge of sexual acts, seductiveness, nightmares and bedwetting, drastic changes in appetite, fear of a particular person or family member, withdrawal, secretiveness, or depression, suicidal behavior, eating disorders, self-injury Neglect: unsuitable clothing for weather, being dirty, extreme hunger, apparent lack of supervision

46 Reporting suspected cases of Abuse Nurses are legally and ethically required to report all suspected cases of abuse Legislation varies, so nurses should be aware of what cases need to be reported and to whom Abuse includes: physical, verbal, sexual and emotional attack; neglect and abandonment Targets of abuse: infants, children and adult men and women of all ages Abusers: men and women of all ages, races, socioeconomic groups and religious backgrounds

47 Reporting suspected cases of abuse In some states, failure to report abuse is a crime Nurses are protected from lawsuits from suspected abusers if report of suspected abuse is submitted in good faith

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