Safeguards to protect PHI The privacy rule requires that reasonable safeguards be used to protect PHI. Such safeguards vary, depending on the organization, the providers involved, the individual patient’s condition, and individual healthcare plans. The rule does not mean, however, that safeguards will absolutely guarantee the privacy of PHI. It is expected that all covered entities evaluate the possibility of violations of confidentiality and privacy and work to eliminate them. Nurses must be completely familiar with their organization’s policies and procedures pertaining HIPAA and PHI (Wacko Guido, 2020).
Following are examples of reasonable safeguards (Wacko Guido, 2020): ● Mandating the use of secure passwords for computers that contain PHI. ● Speaking quietly when it is necessary to converse in public areas, such as hallways or nursing stations. ● Avoiding discussing patient information in public waiting rooms.
HOSPITAL READMISSIONS REDUCTION PROGRAM (HRRP)
and finally, 6) elective primary total hip arthroplasty and/or total knee arthroplasty (THA/TKA; CMS.gov, 2021). This program went into effect in 2010 as part of the Patient Protection and Affordable Care Act (Gia and Pachamanova, 2019). In 2019, Gia and Pachamanova reported examining the Medicare AMI readmissions rate and demonstrated a decrease in readmissions with no negative impact on vulnerable populations (Gia and Pachamanova, 2019). Self-Assessment Quiz Question 6# Sue is an RN who works on a busy medical floor. Today is an exceptionally busy day and she needs to discharge a number of patients, some of whom have COPD or heart failure. She decides to skip going over the discharge instructions with her patients and just provide handouts. What could happen to where she works because of this decision? a. The institution could be charged with a HIPAA violation. b. The patient could be readmitted within 30 days and the facility could be in violation of HRRP. c. The patient could feel their PHI is being exposed. d. There are no issues with what Sue has done.
This is a Medicare value-based purchasing program that encourages hospitals to provide improved communications and care coordination around discharges to decrease avoidable readmissions (CMS.gov, 2021). There are six conditions that are monitored for avoidable hospital readmissions within 30 days. The six conditions are: 1) Acute Myocardial Infarction (AMI), 2) Chronic Obstructive Pulmonary Disease (COPD), 3) Heart failure, 4) Pneumonia, 5) Coronary Artery Bypass Graft (CABG) surgery, Impact on nurses Given nurses are on the front-line during patient education and discharge, it is important for nurses to understand the purpose of the HRRP and how nurses contribute to the overall hospital mission to decrease readmission rates. For example, Bahr, et al in 2020 reported a 7.8% decrease in adult readmissions when the patient had the same nurse for 2 consecutive days before discharge. This was independent of other factors historically related to readmissions (Bahr, et.al, 2020).
ISSUES WITH SOCIAL MEDIA, NURSING, AND LEGAL CONCERNS
Social media and nurses Social media is instantaneous, powerful, and postings are not able to be completely deleted. It has transformed the way people communicate. For nurses, social media can be a useful tool that facilitates professional connections, promotes appropriate and timely communication with patients and family members, and educates and informs both healthcare professionals and healthcare consumers alike. Using social media is not a problem for nurses or other healthcare professionals as long as they remain aware of the scope, standards, and laws that guide their practice. Patients expect nurses to act in their best interests at all times and to respect their dignity and the dignity of loved ones. Unintentional as well as deliberate breaches of patient confidentiality and privacy can cause harm, destroy the nurse–patient professional relationship, and can even have legal implications for nurses who (willingly or inadvertently) breach duty through the use of social media. Occurrences of inappropriate use of electronic media have been reported to state BONs; reported in the nursing and general public media; and, in some cases, have resulted in severe disciplinary action (National Council of State Boards of Nursing, 2018a). The NCSBN has published a white paper titled A Nurse’s Guide to the Use of Social Media (National Council of State Boards of Nursing, 2018a). Although most healthcare organizations have policies that address employee use of social media during work hours, many do not address the use of such media outside of the workplace. When using social media outside the workplace, the nurse is still vulnerable to accusations of professional misconduct such as violations of clients’ rights and confidentiality. This white paper attempts to address some of these occurrences.
A nurse’s use of social media is still guided by professional, legal, and ethical standards. Client information must be protected regardless of whether the nurse is on or off duty. Privacy refers to the client’s expectation and right to be treated with dignity and respect. Federal law reinforces such privacy through HIPAA. Breaches of client confidentiality and privacy can be intentional or accidental and can occur in a multitude of ways. However, even unintentional breaches leave the nurse vulnerable to legal and other forms of disciplinary action. This includes posting information via social media (National Council of State Boards of Nursing, 2018a). A BON may investigate reports of inappropriate disclosures on social media on the following grounds (National Council of State Boards of Nursing, 2018a): ● Unprofessional or unethical conduct. ● Moral turpitude (actions that are immoral, unethical, or unjust). ● Mismanagement of patient records. ● Revealing privileged communication. ● Breaching confidentiality. Nursing consideration: Improper use of social media by nurses may violate state or federal laws, thus making the nurse vulnerable to personal liability claims (National Council of State Boards of Nursing, 2018). Examples of misuse of social media The following are some examples of misuse of social media that have been, unfortunately, well publicized in various media formats.
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