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CONFIDENTIALITY and PRIVACY

Personal Health InformationPRACTICE Standards

By: Ivanka

Julia

Nadia Sen

Professionalism


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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

Agenda


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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 thatinformation and disclose to it others only in accordance

with permissions, rules or laws authorizing its disclosure.(CNA, 2003)


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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).


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Provincial Legislation: personal health information protectionact (Bill 31) (PHIPA)

came into force on November 1, 2004

applies to organizations and individuals involved in thedelivery 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 regardinghis/her personal health information

permits the sharing of personal health information amonghealth care team members to facilitate efficient and effectivecare

personal health information be kept confidential and secure

Personal Health Information

Protection Act


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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.

Collecting Personal

Information


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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

Belongs to the Client


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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)

Personal Health

Information Practices

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.


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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 careteam.

(CNO, 2009)

Knowledgeable Consent

and SubstituteDecision-Makers


obtaining the clients express consent

before disclosing his/her information outsidethe health team;

seeking consent from the substitute

decision maker when the client is incapable

of providing knowledgeable consent.


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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 thatthe record is incomplete or inaccurate, and any changes to the

record must be tracked.(CNO, 2009)

The Clients Right to Access

and Amend His / Her PersonalHealth Information


ensuring that the custodian has providedwritten 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.


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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.(CNO, 2009)

Potential for Harm


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.


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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)

Disclosure without

Consent


ensuring clients or substitute decision-

makers know that information may be used

for purposes other than client care, such asfor research or improvements to the quality

of care;

ensuring that those seeking access to

information have the requisite authority

before providing information.


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Simple Ways to Protect PatientPrivacy 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 testresult on answering machines or with anyone other than the

patient.


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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.


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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 mostimportant 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 informationmight 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.

Summary


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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 thewaiting room can hear the conversation.

What could have been done differently to protect this

patients privacy?


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Answer

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.


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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 thepatients physician for instructions with no success. Finally, shereaches the club where the physician is attending a socialevent. She asks the receptionist to tell the physician thatMr. Olsen has had an adverse reaction to his medication andshe urgently needs a call back.

What should the nurse have done differently?


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Answer

Leaving a message with someone other than the physician that

provides any identifying details about the patient or hiscondition is a breach of confidentiality. If the person receivingthe message knows Mr. Olsen, the information about hispresence at the facility and his condition could lead tospeculation about the patient. The nurse should have simply

requested an immediate call back from the physician about anurgent patient matter.


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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 babyshower 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?


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Answer

Absolutely not. This is clearly an unauthorized use of medical

information. Remember that you should never look at therecords of patients you are not helping to care for.


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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.cna-

aiic.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.

References

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