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Self Study Module

A PATIENT RIGHTS MODULE: MAINTAINING CONFIDENTIALITY

© 1998-2009 In the Know, Inc. May be copied for use within each physi-cal location that purchases this inservice.

PROVIDED BY:

We hope you enjoy this inservice entitled “Maintaining Confidentiality.” It has been prepared especially for nursing assistants like you. You work very hard, and we appreciate the effort you make to complete these educational materials. It shows your desire to continue learning and growing in your profession.

If you are studying the inservice on your own,

please do the following:

• Read through all the material. You may find it useful to have a highlighting marker nearby as you read. Highlight any information that is new to you or that you feel is especially important.

• If you have questions about anything you read, please ask _________________________.

• Take the quiz. Think about each statement and pick the best answer.

• Check with your supervisor for the right answers. You need 8 correct to pass!

• Print your name, write in the date, and then sign your name.

• Keep the inservice information for yourself and turn in the quiz

page to _____________________________ no later than

____________________.

THANK YOU!

Instructions for the Learner What will you learn?

After finishing this inservice, you will be able to:

• Define confidentiality.

• Explain why confidentiality is important for quality client care.

• Describe at least four ways confidentiality can be broken during daily work.

• Discuss HIPAA and its requirements.

• Demonstrate how you maintain confidentiality in your daily work.

A Patient Rights Module: Maintaining Confidentiality

© 1998 (updated 2006)

In the Know, Inc.

306 Brandermill Drive Durham, NC 27713

www.knowingmore.com

May be copied for use within each physical location that

purchases this inservice from In the Know.

All other copying or distribution is strictly prohibited.

Four Easy Ways to Break Confidentiality

2

Terms You Should Know 3

Some Questions and Answers About HIPAA

4

Exceptions to Confidentiality

5

Confidential Documentation

6

Maintaining Confidentiality in the 21st Century

8

Tips for Maintaining Confidentiality

10

What If…? 9

Issues That Affect Confidentiality

7

Inside this issue:

What Does Confidentiality Mean?


As a nursing assistant, you spend more time with your clients than anyone else on the health care team. This helps you develop a close relationship with your clients. They come to trust you with their personal information—believing that you will keep it to yourself.

Now, be honest. Have you ever discussed a client’s private information with your family or laughed about a client with a group of coworkers? Most health care workers would probably answer “yes”.

Talking about your clients in a public place or to people who aren’t involved in their care breaks the trust your clients have placed in you. Health care workers who break confidentiality can lose their jobs and can even find themselves in a lawsuit!

Confidentiality means that:

• Your clients and your coworkers expect you to keep their personal information to yourself, and you expect the same from them.

• You must remember to guard information about your clients as you go through your daily work. It is easy to break confidentiality if you’re not careful.

• When you keep personal information safe, your clients come to trust you. This trust is an important part of your relationship with your clients.

• Health care organizations must promise clients that their medical information will be kept safe. This promise is included in the Patient’s Bill of Rights in all health care facilities. Be sure you understand the Patient’s Bill of Rights where you work.

As a health care worker, you are trusted each day with confidential information about your clients. They feel safe telling you personal details about their lives and their health because they know you will keep it to yourself.

4. Talking To Family Members

John had been caring for Mr. Carter for several weeks. Mr. Carter’s daughter visited and asked John if her father’s blood pressure was okay. John told her that Mr. Carter’s pressure had been high recently because Mr. Carter was eating too many salty potato chips.

If your clients or their families ask you about the client’s condition, tell them to ask your supervisor or the doctor instead of answering yourself.

1. Talking In Front of a Client

A client, Mrs. Jones, had been unconscious for several weeks. Two aides, Sally and Mary, were working together to bathe Mrs. Jones. During the bath, Sally told Mary that she overheard the doctor saying Mrs. Jones will die soon.

Please don’t talk about your clients in their rooms, even if they are unconscious or asleep. You don’t know what your clients might be able to hear.

3. Talking To Other Clients

Susan’s new client, Mrs. Brown, was a friend of Susan’s neighbor. Susan told her neighbor that Mrs. Brown was pretty sick and would probably enjoy a visit.

Even if you mean well, please don’t discuss your clients with anyone outside of work, even your friends and family. They have no business knowing the names or condition of your clients.

You should always be aware of your surroundings when speaking to other health care workers about your client. You never know who may be able to overhear your conversation.

What’s the bottom line?

Remember to THINK before you speak and RESPECT the privacy of your clients.

Four Easy Ways to Break Confidentiality (And How to Avoid Them!)

2. Talking to Co-Workers

During a lunch break with five other nursing assistants, Jim told a story about his client, Mr. Smith. Jim said Mr. Smith was very forgetful and kept trying to eat his dinner with a toothbrush instead of a fork. The whole grouped laughed at Jim’s story.

Even if it seems like a harmless story, please don’t talk about your clients to other employees—unless they are part of the client’s health care team. And then, do it in private, not at lunch. Remember...if Mr. Smith were your father, would you want a bunch of people laughing at him?

A Patient Rights Module: Maintaining Confidentiality © 1998 (updated 2006) In the Know, Inc. Page 2

There are a few common ways that health care workers break their clients’ trust without really meaning to. See if you can spot the mistakes these nursing aides made:

Confidential Information • Is told in secret

• Involves private or secret matters

All personal information about your clients is confidential whether it is about their health, their living situation, their family or their finances. Be sure to keep what you hear about your clients to yourself!

Privacy • Surrounds personal affairs

• Includes information that is not for public view

Privacy is a basic right of all Americans. As a health care worker, you have a responsibility to respect the privacy of all your clients and your coworkers. And, you have the right to expect that your privacy will be respected.

Patient Authorization

• Permission, usually given in writing by the client, must be gotten before client information is given out.

Terms You Should Know


Medical Record

• A permanent written record of a client’s medical treatment.

• A legal document containing confidential communication about the client.

You may be asked to write in a client’s medical record. Or, you may fill out daily activity sheets for your clients that become part of the client’s chart. Either way, this information is confidential!

Patient/Resident Bill of Rights • A listing of the rights and

responsibilities of people who are admitted to health care organizations.

• Confidentiality is one of the basic rights listed on the Patient Bill of Rights.

All health care organizations—including hospitals, nursing homes, home care agencies, hospices and assisted living facilities—have their own “bill of rights” for clients. Be sure you know the Bill of Rights for your workplace.

It is easy to confuse confidentiality and privacy. They are very similar, but confidentiality usually applies to medical records and ensuring that information is available only to those who are allowed to see it. For example:

• Maintaining your clients’ confidentiality involves keeping their medical records away from anyone who does not have the right to see them and never discussing their diagnosis with someone who is not a part of their health care team.

• Maintaining your clients’ privacy has to do with things like not touching their personal possessions, not listening to their private conversations with others, and not entering their rooms or personal space without their permission.

Confidentiality vs. Privacy


Some Questions and Answers About HIPAA What types of information do the HIPAA rules cover?

The rules cover all forms of client information like: • Names

• Social Security numbers

• Addresses and phone numbers

• Fax numbers

• Email addresses

• Medical record numbers

• Dates of birth

• Diagnoses

• Any account numbers or information that identifies clients

Do I have to be more careful with client information around the workplace?

Yes, you must make sure that client information is not visible to the public in places like: • Assignment boards.

• Boards or charts in clients’ rooms.

• Papers like faxes or photocopies.

• Computer screens.

Be aware of any other places where client information can be seen by people who may not be permitted to view it.

What happens if someone breaks the HIPAA rules?

There are fines of $100 per violation and up to $25,000 per year for violating these rules. Fines can be as high as $250,000, and prison sentences of up to 10 years for intentionally using or selling personal health information for personal gain or to harm someone.

I keep hearing about HIPAA. Does it have anything to do with confidentiality?

Yes, it does. In 1996 Congress passed the Health Insurance Portability and Accountability Act (HIPAA), which set up privacy rules to protect clients’ medical records and information. This law was developed by the U.S. Department of Health and Human Services and gives clients more control over how their personal medical information is used and to whom it can be given. A client must give authorization before any personal medical information can be given out.

What is most important for clients to understand about HIPAA?

There are certain rights that HIPAA guarantees clients. The facility or company you work for must have a Patient/Client Bill of Rights posted that tells clients that they have the right to: • Privacy.

• Receive a written Notice of Privacy Practices that describes how their information will be used.

• Access and copy their own medical records.

• Fix mistakes or information in their records that is not accurate.

• Request special instructions for how their information is sent to other places.

• Ask for limits on how their information is used and given out.

• Get a list of all non-routine times when their information may be given out.

• Complain about privacy violations to the institution and to the Department of Health and Human Services.

Your employer’s Patient/Client Bill of Rights may have other rights included along with these.

If you have additional questions about HIPAA, please ask your supervisor.

© 1998 (updated 2006) In the Know, Inc. Page 5 A Patient Rights Module: Maintaining Confidentiality

In most states, children are considered minors until their 18th birthday. In general, while they are minors, their parents have the right to make decisions about their medical care and to be kept informed about their health and well-being. However, there are exceptions. For example, medical information may be withheld from parents:

• When the parents agree that their child and a health care provider may have a confidential relationship.

Confidentiality and Minors • When a health care provider believes that a

child may have been abused or neglected.

• When a child has been declared “independent” from his or her parents—either through court proceedings or by getting married.

The laws covering disclosure of information about minors to their parents varies from state to state. If you are unsure about specific laws in your state, check with your supervisor.

• You are working in a nursing home caring for Mr. Sanders, a client with dementia. One day Mr. Sanders has an argument with another client and you hear him threaten to hit that client. If a client physically threatens to harm you, himself or anyone else, you should report it to your supervisor.

• Your client, Mrs. Robertson, has been attempting to drive a car when she is unfit to drive. If your client is a danger to others, you should report it to your supervisor.

• You have a client, Mr. Anderson, who is having chest pains. In an emergency, you are allowed to share confidential information about your client with emergency personnel. You should report this to your supervisor and/or follow emergency procedures for your workplace.

Did you know that there are times when you are not required to keep a client’s information confidential? Here are some examples of when you should not keep information confidential:

• You are caring for a client, Mrs. Adams. A doctor or nurse who has been treating your client asks for information about Mrs. Adams. You are allowed to share information with another health care provider who is treating your client.

• Your client, Mr. Johnson, has bruises that he did not have the day before. He had no injury that you know about, and when you ask him about it, Mr. Johnson gives you a suspicious reason for his injury. If you suspect your client is being abused, you should report it to your supervisor or the authorities.

Exceptions to Confidentiality


Which of the following do you think “qualifies” as confidential documentation?

• A client’s medical record

• Your client care notes

• A bulletin board listing each client and his or her diagnosis

• The results of a coworker’s TB test

• Your annual job evaluation

• A client’s address and telephone number

• A copy of a doctor’s order

Confidential Documentation What’s the right answer? THEY ALL ARE! Any personal information about you, your clients or your coworkers should be kept confidential. This means keeping medical records and personnel files in locked cabinets, locked rooms or in supervised areas.

What would you do if the following people asked you for information about your client?

• Family members

• Partners

• Friends

The answer is the same for all — politely ask them to speak to your supervisor. Just because they are a family member, partner or friend of your client does not mean that they have the right to information about them.

Remember to be careful when you are talking about your clients. Before speaking, ask yourself:

• Is what I have to say confidential information?

• Is the person I am speaking to part of the client’s health care team?

• Am I in a private place or are there other people around me who shouldn’t hear what I am saying?

• Am I sharing this information for the client’s benefit? Or is it just “gossip”?

Confidentially Speaking...

Be aware that you can be held liable even if you give out your clients’ personal information by mistake.

Question: Do you think you should be told if a client is HIV positive? Do you believe you have the right to know this bit of private information—especially since you might be providing personal care to this person?

Answer: No, you don’t have the right to know if a particular client is HIV positive. As health care workers, we protect ourselves from contagious diseases like AIDS by using Standard Precautions with EVERY client. By treating all your clients as if they might have an infectious disease, you can protect yourself without knowing a particular client’s HIV status.


More and more medical information is being collected and stored on computers. In general, this is a good thing, making it easier to diagnose disease, monitor patients, organize the data about their conditions, and transmit the information to insurance companies. However, along the way, hundreds of people may scan an individual’s health records—and some of them may not have good intentions. Remember...medical records contain intimate information about a person’s physical condition, disabilities, mental health, dietary and drug use, recreational habits, sexual

Medical Records For Sale practices, and more. In the wrong hands, this information could lead to embarrassment, job loss, or even ruined lives.

Did you know that there is a “black market” for medical records? According to private investigators, almost anyone’s medical record may be bought for about $250. For example, this is how tennis player Arthur Ashe's HIV status became public knowledge. What a horrible (and illegal) invasion of privacy!

health insurance policy. Recently, Mary applied for a new job. The people there found out that she is likely to develop breast cancer and now they don’t want to hire her. There are many people who would like to have genetic testing but are afraid it will affect their lives like it did Mary’s.

Do you see how important it is to keep medical information confidential?

Did you know that there are a number of diseases for which a genetic test can be done? For example: Mary’s mother died from breast cancer. Mary learned about a blood test that will tell her if she has the “breast cancer gene”. Mary really wanted to know if she is likely to get the disease, so she had the test. Unfortunately, the test showed that Mary does have the breast cancer gene. Her health insurance company found out and threatened to cancel her

The Impact of Genetic Testing on Confidentiality

Many doctors think this is a good idea since it will make it easier for them to learn about a new client. Insurance companies think it’s great, too, because it will be easier to keep track of patients. As of July 2005, the Federal Drug Administration is conducting a final review to determine if hospitals can use computer chips containing personal medical information that are implanted under a patient’s skin. However, many Americans are opposed to using medical ID numbers at all and their use is still being debated. What do you think?

In 1996, Congress passed a law ordering the U.S. Department of Health to give all Americans a special Medical ID Number. This number would be different for each person, just like a Social Security Number. The plan is to save each person’s entire medical history in a computer. Then, health professionals would be able to find out all about their patients by putting the Medical ID Number in the computer.

Have You Heard About Medical ID Numbers?


Maintaining Confidentiality in the 21st Century The March of Dimes decided to register all children born with birth defects so they would know how many kids were born with each kind of defect. The March of Dimes checked with hospitals and made lists of all babies born with birth defects. The problem? The children were put on the list without their parents’ permission.

• One solution: Get permission before obtaining any medical information about others. Or, if you are the patient, ask specifically how your medical information is being safeguarded.

Marian participated in an informal health screening at her local mall. While at the screening, she had her cholesterol levels, blood pressure and weight checked. Without her knowing about it, her medical information was passed onto direct marketers. Now, she is getting all kinds of sales calls and junk mail from companies that want to sell her products to help control her weight and her cholesterol.

• One solution: Before participating in health screenings offered in public places, such as shopping malls, ask what will happen to the medical information they collect from you. If you are not given the opportunity to say "no" to the sharing of your medical information with others, don't participate.

We live in the “Computer Age”. Information is easy to come by—even when it’s supposed to be confidential. Consider the ways that confidentiality has been broken by people using computers:

Bill was worried that he might be HIV positive, so he bought a home testing kit over the phone using his credit card. The credit card company sold information about Bill’s purchasing patterns and now—because he bought the testing kit—he is on a list of HIV positive people (even though he tested negative on the HIV test).

• One solution: Purchase sensitive testing material with cash.

Susan had been divorced for several years when she realized that alcohol had become a problem for her. She got treatment for her alcohol addiction and got a great new job. Then, her ex-husband, David, sued her for custody of their son. Before the court date, David managed to “break” into Susan’s computer and read emails that Susan had written to her family about her alcohol treatment. He used this information against her in court and the judge gave him full custody of their son.

• One solution: Don’t write anything in an email that you wouldn’t want the whole world to know!

Be sure you know your workplace policy about maintaining confidentiality when using:

Computers Cell Phones Email

Q: Pretend your client, Mr. Brown, tells you that he has fallen down three times in the last few days. He asks you not to tell his daughter or anyone else since he doesn’t want to worry anyone. He says he knows he can trust you to keep it a secret. What would you do?

A: You need to tell Mr. Brown that it is your duty to report any changes in his condition to your supervisor. You want him to continue trusting you, but you must tell your supervisor about the falls. Remind Mr. Brown that you want what is best for him, and that his safety is your responsibility. Tell him that you will not say anything to his daughter, only to your supervisor. Report the client’s condition to your supervisor, but be sure to say that you were not present when he fell. Also, let your supervisor know that Mr. Brown is worried about his daughter finding out. Your supervisor will follow up with the client according to policy.

Q: Let’s say that a fellow employee tells you in private that she may have a drinking problem. While there have been no problems with her client care, you are afraid there might be, so you tell your supervisor what she said. Your supervisor fires the employee immediately. Have you broken confidentiality about your coworker?

A: This is a difficult situation, but, yes, you have broken confidentiality. Your fellow employee could sue you for not keeping the secret, saying you caused her to lose her job. However, you also have a responsibility for keeping clients safe. Instead of telling the supervisor yourself, you might try encouraging the coworker to talk to the supervisor about her drinking problem. Some workplaces have programs to help employees with drug or drinking addictions. (NOTE TO INSTRUCTOR: Obviously, this is a complex issue. You may want to explore it further based on your workplace policies.)


What If… ? Some Examples of Maintaining Confidentiality

Q: Why is confidentiality such an important part of your relationship with your clients?

A: Remember that clients have to talk to you about private things such as pain, skin rashes, bowel movements, and urination. Think of how embarrassing it would be if it was announced to everyone at work that you had three loose bowel movements today! You would never want to tell anyone about your bowels ever again. If a client believes he can trust you to keep his information confidential, he will continue telling you how he feels. If you break confidentiality, the client might stop telling you when his condition changes. That could be dangerous for the client!

• Be aware of who is around you whenever you speak about a client. Remember that you are responsible for what you say, and that health care workers have been sued for saying the wrong thing at the wrong time!

• All medical information is confidential, especially about a client with HIV. Every state has laws about how to handle HIV information. Be sure you know what the law is in your state. Ask your supervisor for more information.

• Think of your clients’ medical information as something they own. You wouldn’t take a client’s clothes and pass them around to other people. So, don’t pass around a client’s private information either.

• Be careful if you use a cellular telephone during your work day. When you talk on a cell phone, your conversation might be picked up by strangers. Never give a client’s full name or address over a cell telephone.

• If you leave messages about your clients on an answering machine or a voice mail system, be careful what you say. You never know who might hear the message.

• Never leave any charts, papers or computer screens containing client information visible in public areas. Others may be able to see them.

• If you work at a facility, avoid talking about clients in public areas like the cafeteria or front desk. You never know who may be able to hear you.

Tips for Maintaining Confidentiality


• After viewing client information on a computer, don’t leave without logging off of the computer first. Also, don’t share computer passwords or codes with anyone.

• Remember that each client’s chart—or medical record—belongs to your workplace. The medical record must be kept safe and secure at work. The information in the medical record belongs to each client. Please treat it as their personal private property.

• Do not share personal information about your coworkers with anyone. For example, if Mary covers for Betty one day, she should not tell the client that Betty had to stay home because she’s pregnant again and has morning sickness! Don’t break confidentiality about your coworkers.

• Always be careful with what you say. For example, Tom was late with his client’s bath. He said, “Sorry. I would have been here sooner, but Mr. Smith had diarrhea and I had to clean him up all over again.” Tom broke confidentiality by talking about Mr. Smith to another client!

• It is important for you to share confidential information with your supervisor if it involves a client’s health or well-being. For example, if a client tells you that the right side of his body has gone numb, you do not keep that information secret! Let your supervisor know right away.

EMPLOYEE NAME (Please print):

___________________________

DATE: _____________________

• I understand the information presented in this inservice.

• I have completed this inservice and answered at least eight of the test questions correctly.

EMPLOYEE SIGNATURE:

_______________________

SUPERVISOR SIGNATURE:

_______________________

Inservice Credit:

Self Study 1 hour

Group Study 1 hour

File completed test in employee’s personnel file.


Circle the best choice and then check your answers with your supervisor!

1. True or False Confidentiality is one of the basic rights for clients and for employees.

2. True or False It’s okay to give confidential information to a member of the client’s family.

3. Client information that should be kept confidential includes: A. The client’s medical diagnosis. B. The names of the medications taken by the client. C. The client’s vital signs. D. All of the above.

4. If a visitor asks you if your client is going to die, you should say: A. “It sure looks that way.” B. “We’re all going to die someday.” C. “I’m sorry. I can’t discuss the client’s medical condition with anyone.” D. “It’s none of your business.”

5. True or False It’s part of your job to keep your client’s medical information private.

6. True or False If a client tells you he wants to kill himself, you must not tell anyone.

7. True or False The HIPAA law only applies to health care workers who use a computer on the job.

8. True or False In most states, parents usually have access to the medical records of their children until the children turn 18 years old.

9. True or False If people work at the same place you do, it’s okay to discuss a client with them.

10. True or False Respecting a client’s privacy and maintaining their confidentiality mean the same thing.

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