Breach of Confidentiality”
a. How do you feel about the trauma physician contacting Sara to tell her that her boyfriend was coming to the ED? Did this contact violate any standards, rules, or regulations?
b. With whom would responsibility and accountability rest if a poor patient outcome occurred while Sara was off the unit: Kelly and/or Sara? Why?
c. Think about the patient records you have encountered in your clinical experiences. Do you feel it is easy for nurses and other staff to access patient medical records, even for those patients for whom they are not providing care? What issues could this lead to? Who might need access to records of patients for whom they are not providing direct care?
d. Do you feel a violation of patient privacy and confidentiality is grounds for immediate termination based on a policy of progressive discipline, even if it is an individual’s first offense?
Case Introduction
Sara, a staff nurse, is working on the unit when she receives a concerning call from her friend who is a trauma physician in the Emergency Department (ED). Sara’s boyfriend is coming into the ED after a motor vehicle collision. The trauma physician wanted to give Sara a “heads up” so she can come see him before his wife arrives. Sara heads to the ED to check on him and later returns to the unit distraught.
PART 1:
Secretary: Sara, you have a call on Line 2.
Nurse Sara: Hello this is Sarah.
Doctor: Hey, Sarah, it’s Doctor Taylor. I’ve got some bad news. I just heard that your boyfriend John is coming into the Ed. It wasn’t a crash on I-95.
Nurse Sara: What? How is he? Is he conscious?
Doctor: I don’t think it’s too serious. But you need to come down here quickly if you want to see him before his wife gets here.
Nurse Sara: Yeah, OK. I’ll be down in a few minutes. Kelly, could you just wash my patience for a few minutes? I have to run downstairs. Yeah, sure. OK. Is everything alright? Yeah. I will tell you when I get back.
Nurse Kelly: Sara… way… What about?… Report.
Part 2:
Nurse Kelly: Sara. I thought you said you’d be right back. Mr. Thomas’s IV in bed is leaking all over the place. And the doctors have been yelling.
Nurse Sara: I’m sorry. It’s just…it’s John. He’s been in a wreck. And I had to go downstairs before his wife.
Nurse Kelly: What? That’s terrible. Did he call you from the ambulance?
Nurse Sara: No. Doctor Taylor called me from downstairs.
Nurse Kelly: Really? She did. Well, I guess that’s nice of her. But listen, anyway, you really need to check on Mr. Thomas.
Nurse Sara: You just hold on. I just need to make sure John is OK before he goes into surgery. Ok his chart says he fractured his tibia. So, he does not need any blood because prior labs came out fine. I’m so thankful his alcohol screen came back negative.
Nurse Kelly: are you looking at his chart?
Nurse Sara: Yes, but it’s just because I’m so worried about him and I just got to make sure he’s going to be OK.
Nurse Kelly: I know you’re worried, but Are you sure that’s a good idea?
Part 3:
Nurse Supervisor: Sara, I called you in here because the medical records department came across something irregular when they were conducting their routine audit last Friday. It’s showing that you access to the medical records of John Jacobson, a patient who came into our Ed that afternoon.
Nurse Sara: I know, I know. And I’m really, really sorry. It’s just that John is the guy that I was telling you about, the guy that I’m dating, and I was just really worried about him. I’m sure you can understand.
Nurse Supervisor: I can understand your concern. However. It’s illegal for you to access his medical record. Even he needs written authorization to do that. We covered that in your orientation and your annual mandatory training ensuring compliance with patient privacy and confidentiality.
Nurse Sara: I know. I’m really sorry. And I promise it won’t happen again. It’s just. I was really worried about him. He was going to have to have a surgery.
Nurse Supervisor: I understand your concern. However, this is a serious violation on your part. Based on our policies. We’re going to have to let you go. I’m going to need you to clean out your locker and…
Nurse Sara: Don’t I get a warning first? But I’ve never done something like this before and I said it won’t happen again. I mean, don’t I need to get a warning first?
Nurse Supervisor: This offense is grounded for immediate termination. The hospital follows very strict guidelines when it comes to HIPAA violations. I’m going to need you to clean out your locker and leave immediately.
