Anyone been running into this lately?

Buzz

Forum Captain
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Nursing Homes (or even a few hospitals) refusing to hand over a patients' chart to you when you arrive to pick up the patient...

Ran into this last night at a nursing home. Patient had dementia and we were taking him to a sleep study. I asked nicely to see the patient's chart so I could copy down his medications, allergies, history and whatnot and the nurse refused citing HIPAA as her reason...

Also ran into it recently while on an emergency run. Had to rely solely on the report and a sloppy handwritten med list she gave me when we arrived. Granted, those are things you might not even have when responding to a residence, but still is there any reason for them to deny information that they have about the patient's condition?
 

PapaBear434

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I have only had one or two good experiences with nursing homes. Most of the time, I see some of the lowest level nurses doing such a horrible job... It's like they haven't done a proper assessment in years, and seem to have no interest in doing so.

Always "lose" the paperwork, "forget" to get a set of vitals before we show up (or they are obviously made up), and if either one of these is done they are likely to be wrong.

Maybe I'm just in a bad area for nursing homes or something.
 

redcrossemt

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I asked nicely to see the patient's chart so I could copy down his medications, allergies, history and whatnot and the nurse refused citing HIPAA as her reason...

I assume someone at that facility got word of the changes to HIPAA and ran around telling all of the staff to not say anything to anyone.

If you weren't aware yet, there have been some changes to HIPAA that were enacted as part of the Stimulus Bill. Most of the changes related to how covered entities share information with their business partners. There's also new wording that bans the sale of PHI, requires additional accounting on electronic health records, and notification of patients when their PHI is accidentally released.

Page, Wolfberg, and Wirth has a page on the changes at http://www.pwwemslaw.com/content.aspx?id=396. I have no ulterior motives or undisclosed interests, but if you are a privacy officer, you should consider signing up for the PWW webinar on that page for an update.

Note that that law was never designed to prevent transfer of information between healthcare providers, and still allows the sharing of things like medical history, medications, drug allergies, and other information you need to know to provide the best care to the patient.
 

Sasha

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It's frustrating when they refuse to hand you the chart, but hey.. some EMTs and Medics give them a reason.

Only health care professionals look at the charts. There is a lot of unprofessional EMTs, especially IFT. Not knocking IFT companies. I loved working IFT but a lot of people don't take it seriously enough because it's "just transport" and don't care or on the flip side, they blow smoke up their butt because no one takes them seriously enough, are rude and mean to nurses and staff and leave a sour taste in their mouth.

I've found that politely reminding the nurse that you are an EMT, not just a "transporter" and they are transferring care of the patient to you sometimes helps.

If they still wont give it up, most of the information on the chart can be found in the patient's packet you just gotta look through it. The only reason I ever looked at the chart is if the paperwork was incomplete, the nurse was still working on the packet when we got there, and to to swipe an ID sticker.
 
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Ridryder911

EMS Guru
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Here is how I handle that, inform them either to have proper (with needed information) and to be legible, or please go get the person in charge. If it is the LPN/LVN that is discussing this with you; then ask for the Director of Nurses name to make a call later.

Personally, I have never asked to see the chart as it has too much B.S. within it to decipher what is needed. I do though ask for a complete transfer sheet w/med list.

As a person whom is responsible for administering care, HIPAA is not involved at this level.

R/r 911
 
OP
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Buzz

Buzz

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I assume someone at that facility got word of the changes to HIPAA and ran around telling all of the staff to not say anything to anyone.

If you weren't aware yet, there have been some changes to HIPAA that were enacted as part of the Stimulus Bill. Most of the changes related to how covered entities share information with their business partners. There's also new wording that bans the sale of PHI, requires additional accounting on electronic health records, and notification of patients when their PHI is accidentally released.

Ah, that probably is the reason for their refusal. I've never had an issue at most of these places before.
 

karaya

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Premium Member
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I assume someone at that facility got word of the changes to HIPAA and ran around telling all of the staff to not say anything to anyone.

If you weren't aware yet, there have been some changes to HIPAA that were enacted as part of the Stimulus Bill. Most of the changes related to how covered entities share information with their business partners. There's also new wording that bans the sale of PHI, requires additional accounting on electronic health records, and notification of patients when their PHI is accidentally released.

Page, Wolfberg, and Wirth has a page on the changes at http://www.pwwemslaw.com/content.aspx?id=396. I have no ulterior motives or undisclosed interests, but if you are a privacy officer, you should consider signing up for the PWW webinar on that page for an update.

Note that that law was never designed to prevent transfer of information between healthcare providers, and still allows the sharing of things like medical history, medications, drug allergies, and other information you need to know to provide the best care to the patient.

The changes in the stimulus bill chiefly focus on Business Associates, which EMS provider would usually not be considered a BA since they too are a covered entity. And the new changes don't go into effect until this time in 2010.
 

JPINFV

Gadfly
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The only two problems I've ever encountered was them sealing the envelope and telling me that it's "for the hospital," and them not providing a copy of the MAR (which I ask for since the ER usually wants a copy of it). The first is easily handled once the doors to my ambulance close.
 

Ridryder911

EMS Guru
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The changes in the stimulus bill chiefly focus on Business Associates, which EMS provider would usually not be considered a BA since they too are a covered entity. And the new changes don't go into effect until this time in 2010.

Yeah, I just read the new amend to the HIPAA reg. It has very little to do with the street medic, but may affect billing services and contract review services for insurane payors. Again, alike discussed will not be effective for a while.

R/r 911
 

firecoins

IFT Puppet
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At my IFT company we are run by a health network that is owned by the 4 hospitals we serve. They have sheet that informs them what we need ahead of time. This way we don't run into such problems. Usually if there is a problem it is because the person preparing the file is new. This is easily fixed.

I have befriended many of the techs, RNs and MDs who work at the facilities I frequently attend. Therefore they recognize me and will often give me a full verbal report even on the most routine of trips.
 

medicdan

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I run into this fairly often, I take daily tours of some of the worst nursing homes in the area. I keep insisting that I need the chart in order to take the patient off their hands-- as soon as I say "take this patient away" they tend to comply. This really is not a HIPAA issue-- we are medical professionals (well some are), and we need this information in order to take care of our patients.

Some EMTs at my company have gotten into the habit of calling and confirming their patient's appointments before transporting, because these nursing homes screw up appointments so often.

Once I get the chart, I look for a face sheet (towards the front, because it is guaranteed to have correct name, address, SSN, etc), recent hospital discharge paperwork (more legible and trustworthy then SNF paperwork, used to get PMH, meds, allergies).
 

amberdt03

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I have only had one or two good experiences with nursing homes. Most of the time, I see some of the lowest level nurses doing such a horrible job... It's like they haven't done a proper assessment in years, and seem to have no interest in doing so.

Always "lose" the paperwork, "forget" to get a set of vitals before we show up (or they are obviously made up), and if either one of these is done they are likely to be wrong.

Maybe I'm just in a bad area for nursing homes or something.


almost everytime i go to a nh for a call, the nurse always says, " i just came on" or "this is normally my patient" and i'm like does nobody talk to each other here. anybody else get that?
 

Veneficus

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almost everytime i go to a nh for a call, the nurse always says, " i just came on" or "this is normally my patient" and i'm like does nobody talk to each other here. anybody else get that?

The better question would be: "does anybody not get that line?"

I better stop now before I really post what I think of nursing homes.
 
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CAOX3

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How would HIPPA apply to this? The pt is now in your care, which makes their information lawfully available to you.
 

Aidey

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Some EMTs at my company have gotten into the habit of calling and confirming their patient's appointments before transporting, because these nursing homes screw up appointments so often.

TBH that is a good idea, and I might start doing that myself. The other day we picked up a 400lb+ woman who was "scheduled" to get a PICC line placed. After loading her into the ambulance the hospital we were taking her to went on divert. We called to make sure they would still take our patient, and they had no record of her being scheduled so they told us we were SOL. We ended up parking the rig and calling all the local hospitals to find someone who could do the procedure so we didn't have to take her back since she did geniunely need the PICC line.
 

sir.shocksalot

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almost everytime i go to a nh for a call, the nurse always says, " i just came on" or "this is normally my patient" and i'm like does nobody talk to each other here. anybody else get that?
All the time. I'm pretty sure thats just nursese for "The reason why I know nothing about this patient is because, in spite of the patient having been here for a week, I have not once seen this patient while s/he was conscious." My favorite is being called to a dementia facility for ALOC and the nurse just says the patient is confused and walks off to do other things.
 

TransportJockey

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One SNF tried that when I was working IFT. It stopped real quick when I said that the pt was NOT going to the hospital (friday night of a 3 day weekend, where it looked like that LPN just had this one pt... pt didn't seem to need to go to the ED for a consult, and that came from my medic partner) unless I could see the information I was asking for IE face sheet, meds, allergies, pmhx, hpi... The LPN didn't seem to know anything I asked.
 

amberdt03

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All the time. I'm pretty sure thats just nursese for "The reason why I know nothing about this patient is because, in spite of the patient having been here for a week, I have not once seen this patient while s/he was conscious." My favorite is being called to a dementia facility for ALOC and the nurse just says the patient is confused and walks off to do other things.

yes i love that one too. i like telling the RN in my report that we are coming in with an altered LOC and saying with a Hx of Dementia. I always ask the nursing home nurse How do you know they are altered?
 

Hockey

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While I was in dispatch, I had one nursing facility call and say the patient had a stroke "last night and either someone didn't notice it or they forgot to call but this patient is going to need to go to the hospital whenever you can get here. " I go "OK I'll get them there right away"

She comes back with "No no no there is no need to run lights and sirens on this I think he had a stroke thats all"

I smacked my hand on my head and just said "OK Goodbye"

I wouldn't even send my worst enemy to this facility. They play IMHO "depressing death music" on the floor. For those who have heard it, you understand...


As for the OP, we run into this problem quite often. Not as much lately, but we do. I usually have learned to not ASK but to TELL the person you need such and such information. Seems when you ask they tell you no or throw a fit. When you TELL the person, it seems they just bend over and do it and gripe. But it gets done immediately.
 
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ffemt8978

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I had a problem one time with the SNF nurse saying that she had already called report to the hospital, and that I didn't need it from her. I asked her for it again, and when she refused I stated, "Well, you will need to call somebody to pick you up from the hospital, because we don't transport employees back to their work."

She stopped for a moment, and then asked me what I meant by that. I replied, "Either I get a report and accept patient care from you, or you come with us and keep patient care during the transport. Doesn't matter to me either way."

I got my report and a phone call from my boss asking me why I refused to accept patient care for a patient. Once I explained what happened, my boss called the SNF and gave them an "attitude adjustment".
 
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