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CONFIDENTIALITY and PRIVACY Personal Health Information

PRACTICE Standards Professionalism

By: Ivanka Julia Nadia Sen

Introduction to Privacy and Confidentiality Personal Health Information Protection Act (PHIPA) Collecting Personal Information Personal Health Information and to Whom it Belongs Five Standard: Personal health information practices Knowledgeable consent and substitute decision-makers The clients right to access and amend his/her personal health information Potential for harm Disclosure without consent

Privacy The rights of a patient to control the distribution and release of data concerning his or her illness. Failure to observe this aspect of a patients rights is classed as an invasion of privacy.
(Tabers Cyclopedic Medical Dictionary, 2005)

Confidentiality The duty of someone who has received confidential information in trust to protect that information and disclose to it others only in accordance with permissions, rules or laws authorizing its disclosure.
(CNA, 2003)

Nurses have ethical and legal responsibilities to maintain the confidentiality and privacy of client health information obtained while providing care.
(CNO, 2009)

Nurses recognize the importance of privacy and confidentiality and safeguard personal, family and community information obtained in the context of a professional relationship."
(CNA, 2008).

Personal Health Information Protection Act

Provincial Legislation: personal health information protection act (Bill 31) (PHIPA) came into force on November 1, 2004 applies to organizations and individuals involved in the delivery of health care services a majority of the act governs personal health information established to set out rules for the management of personal health information and outlines the clients rights regarding his/her personal health information permits the sharing of personal health information among health care team members to facilitate efficient and effective care personal health information be kept confidential and secure

Collecting Personal Information

is any identifying information about clients that is in verbal, written or electronic form; collect as much information as is needed to meet the purpose of the collection; uses client information only for the purpose(s) for which it was collected; it remains secure within the health care team.

Personal Health Information Belongs to the Client

The legislation recognizes that personal health information belongs to clients and is simply being housed in health care facilities. Clients have the right to give, refuse or withdraw their consent to the collection, use and disclosure of their personal health information.
(CNO, 2008)

Professional misconduct One of the definitions of professional misconduct in the Nursing Act of 1991 is to giving information about a client to a person other than the client or his or her authorized representative except with the consent of the client or his or her representative or as required or allowed by law.

Personal Health Information Practices

Nurses share relevant information with the health care team, whose members are obliged to maintain confidentiality. Nurses must explain to clients that information will be shared with the health care team and identify the general composition of the health care team.
(CNO, 2009)

The nurse meets the standard by: maintaining confidentiality of clients personal health information with members of the health care team; collecting only information that is needed to provide care; not discussing client information with colleagues or the client in public places.

Knowledgeable Consent and Substitute Decision-Makers

Nurses ensure that clients are aware of their rights concerning their personal health information and have expressly consented to the collection, use and disclosure of information outside the health care team.
(CNO, 2009)

The nurse meets the standard by: obtaining the clients express consent before disclosing his/her information outside the health team; seeking consent from the substitute decision maker when the client is incapable of providing knowledgeable consent.

The Clients Right to Access and Amend His / Her Personal Health Information
Nurses respect the clients right to see/obtain a copy of his/her health information, to see his/her health file and to request correction to the information. The onus is on the client to prove that the record is incomplete or inaccurate, and any changes to the record must be tracked.
(CNO, 2009)

The nurse meets the standard by: ensuring that the custodian has provided written notice to clients about information practices and that clients are aware of their personal health information privacy rights; facilitating client access to information about care and treatment.

Potential for Harm

When a nurse learns information that, if not revealed, could result in harm to the client or others, she/he must consult with the health care team and, if appropriate, report the information to the person or group affected.

The nurse meets the standard by: considering if any harm may come to a client as a result of a disclosure; reporting information as required by law; consulting with the health care team when there are concerns about harm resulting from sharing information with a client.

(CNO, 2009)

Disclosure without Consent

Nurses adhere to legislation that requires them to reveal confidential information to others. For example, the Child and Family Services Act, 1990 requires all health care professionals to report suspected child abuse to the Childrens Aid Society.
(CNO, 2009)

The nurse meets the standard by: ensuring clients or substitute decisionmakers know that information may be used for purposes other than client care, such as for research or improvements to the quality of care; ensuring that those seeking access to information have the requisite authority before providing information.

Simple Ways to Protect Patient Privacy and Confidentiality

Close patient room door when discussing treatment and administering procedures; Close curtains and speak softly in semi-private rooms when discussing treatment and administering procedures; Avoid discussions about patients in elevators and cafeteria; Do not leave massage regarding patient conditions or test result on answering machines or with anyone other than the patient.

Simple Ways to Protect.........

Do not leave record unattended in an areas where others can see it; When finished using patient health record returned to its appropriate location; When finished looking at electronic patient health record log of the system; When discarding paper patient health record make sure the information is shredded in a secure bin.

Ask yourself. Do I want to know this information or do I NEED to know it? and Do I have a right to know this information? Use Good Sense. Along with following facilitys policies and procedures, using a common sense is one of the most important ways to help protect patient privacy and confidentiality. Think before speak. Be aware of whether others can over hear your conversation. If you think that certain information might be confidential, treat it as such. This is a key part of protecting patient privacy and confidentiality. Handle patients medical records with the same care that you would want your own medical records handled. Respect every patients right to privacy and confidentiality.

Case Scenario # 1
Consider the example of a male patient in the waiting room. Hes the only male in the room. His physician is discussing his condition- testicular cancer with a nurse, and everyone in the waiting room can hear the conversation. What could have been done differently to protect this patients privacy?

The caregiver should have tried to find a private room or area where details could not be overheard. Even when the patients name is not specifically used in conversation remember that details about his condition can be identifying factors in certain circumstances.

Case Scenario # 2
Mr. Olsen, a patient in a facility, has had an adverse reaction to his medication. The nurse tries several times to reach the patients physician for instructions with no success. Finally, she reaches the club where the physician is attending a social event. She asks the receptionist to tell the physician that Mr. Olsen has had an adverse reaction to his medication and she urgently needs a call back. What should the nurse have done differently?

Leaving a message with someone other than the physician that provides any identifying details about the patient or his condition is a breach of confidentiality. If the person receiving the message knows Mr. Olsen, the information about his presence at the facility and his condition could lead to speculation about the patient. The nurse should have simply requested an immediate call back from the physician about an urgent patient matter.

Case Scenario # 3
Susan is a nurse in the ER of a city hospital and she has just heard through the gossip that a fellow nurse is pregnant. The other staff members would like to give this nurse a baby shower but nobody knows when the baby is due or whether it is a boy or girl. Susan has access to the records and could easily find the answers to both questions. Should Susan try to get the information?

Absolutely not. This is clearly an unauthorized use of medical information. Remember that you should never look at the records of patients you are not helping to care for.

Canadian Nurses Association (2003). Privacy and health information: challenges for nurses and for the nursing profession. Ethnic in Practice for Registered Nurses. Retrieved on November 22, 2010, from http://www.cna-iic.ca/cna/documents/pdf/Publications/Ethics_Pract_Privacy_ Health_Nov_2003_e.pdf Canadian Nurses Association (2008). Code of ethics for registered nurses. Retrieved on November 22, 2010, from www.cnaaiic.ca/cna/documents/pdf/.../Code_of_Ethics_2008_e.pdf College of Nurses of Ontario (2009). Confidentiality and Privacy Personal Health Information. Retrieved on November 22, 2010, from http://www.cno.org/Global/docs/prac/41069_privacy.pdf Venes, D. (2005). Tabers cyclopedic medical dictionary (21th ed.) Philadelphia, PA: F. A. Davis Company.