CONFIDENTIALITY

TSERING PALDON
2ND YR MSC NURSING
MCON, MU, MANIPAL

Meaning:
Confidentiality is a set of
rules or a promise that limits
access or places restrictions
on certain types of
information.

It includes
Keeping information protected from
unauthorized viewers
Ensuring that information is
accessible only to those authorized
to have access
Refers to an ethical principle
associated with several professionsprivileged
Trusting another person with
information that will not be shared

Confidentiality in the Workplace

Confidentiality in the workplace can
be defined as keeping the employee,
customer and client information
private.

 Confidential information handled

in aworkplaceincludes things like
client records, business planning and
forecasting, employee records, and
information collected in the course of
research and development.

Importance of Confidentiality in
Workplace

Professionalism
Safety
Security

Responsibility in maintaining
confidentiality:
Employee should:
treat all information as private
should know what files or materials he is
permitted to access in the office and he
should adhere to that.
never answer questions involving
confidential information over the
telephone without establishing the identity
and
authenticity of the caller

 All decisions to breach confidence

must remain strictly limited to the
needs of a given situation at that
time.
Where it is judged to be necessary to
share confidential information with
another agency, the client should be
contacted before doing so, and their
permission sought.

Employer should:
Keep the data which is collected to
hire, manage and pay the employees
confidential.

Responsibility of the HR
personnel:
Devise policies and develop such
procedures which ensure that
workplace confidentiality is
maintained
Communicate the same to all the
employees, supervisors and
managers and train them.

 Safety of
electronically
stored
information

Safety of manual
records

Proper disposal of
sensitive information

Situations when data can be released

without the clients consent:

For the purpose of reporting abuse,

neglect or domestic violence to the
proper social service or protective
services agency.
To prevent serious threat to health
and public safety
To the department of public health
for health reporting purposes

 Inform appropriate bureau during

disaster relief
Workers Compensation
To medical examiners, coroners,
procurement of organ, or certain
research purposes

Breaches
ofworkplaceconfidentiality
Customers donot work with
companies they think are not
trustworthy.
Companies can also experience
compromises in their long term
business plans if information about
products in development or ideas a
company is considering are released
prematurely.

Employee Consequences for

Breach of Confidentiality

Termination
Lawsuit
Criminal Charges
Reputation

Patient Confidentiality:
Patient confidentiality generally
refers to a patients trust that health
information will only be shared with
those who need to know, and in
order to provide appropriate care.

Patient privacy and confidentiality

generally refers to a patients right
to:
decide what personal health information
can be shared with others.
decide how that information can be
shared, and with whom it may be
shared.
not have information about client
discussed in areas where others could
overhear.

Value of confidentiality:
Natural human desire for privacy
Fear of social embarrassment or
disapproval
Fear of discrimination, stigmatization
Information may be misused against
patient
Builds confidence and open
communication

 Demonstrates healthcare
professionals fidelity to the patient.
Respects patients privacy, dignity
and individuality.
Encourages free exchange of
information.

What is considered
confidential?

Breach of
Confidentiality:
Discussing private information
casually with others is an abuse of
confidentiality.
Nursing reports and interdisciplinary
team case conferences are examples
of acceptable forums for the
discussion of privileged information.

Situations when confidential

information may be disclosed:
1.
2.
3.
4.
5.

with patients consent

for benefit of patient
prevent harm to others
when required by Law
medical research, audit, registries

1. Disclosure with patients

consent:
Should be attempted at all times
possible
Patient understands nature &effects
of disclosure
Reports to 3rd parties( insurance,
employer,) must always be with
consent - written consent
Husband/ wife/ family cannot be

2. Disclosure for patients benefit:

In times of emergency
If patient is incompetent
Implied consent when care is shared
among professionals
For the benefit of patients care
To prevent harm to patient - child
abuse

3. Disclosure to prevent harm to

others
4. Disclosure required by law:
Order of court - medical litigation,
criminal cases, compensation.
Providers must report cases of
suspicious deaths or certain injuries,
such as gunshot wounds.
Public health risk - Infectious Diseases
Act

5. Disclosure for medical audit,

research, registries:

Should be approved by ethics committee

Ensure no harm to patient
Delink patients identifiable data
Registries operated under principle of
medical confidentiality
Where feasible obtain consent or inform
patient

OUTCOMES related to breach of

confidentiality.

Positive Outcomes:
Suspected abuse or neglect can be
investigated
Possible future abuse and neglect may
be avoided or prevented
A suicide or attempted suicide may be
prevented
Appropriate interventions may be
initiated for a client to get help in
appropriate related areas.

Negative outcomes:
The facility or agency may reprimand a
healthcare worker (disciplinary action).
The client may suffer embarrassment
and emotional distress
Irreversible damage may be done to the
caregiver/ care receiver relationship.
The client may file charges against the
healthcare worker, staff, and facility.

Guidelines for protecting

private
and
confidential information

Discussion of patients
information:
Discuss client information ONLY in a
place that is away from other patients,
families and visitors.
Report should not be given at the
nurses station.
Never discuss patients in an elevator,
in a hallway, cafeteria, or any other
public
place within or outside of
the facility.

Elevator Talk: Observational Study of Inappropriate

Comments in a Public
Space

A study was conducted to determine

the type and frequency of
inappropriate comments made by
hospital employees while riding
hospital elevators.
The researcher overheard a total of
39 inappropriate comments, which
took place on 36 rides (13.9% of the
trips).

The most frequent comments (18) were

violations of patient confidentiality.
Next most frequent (10 comments) were
unprofessional remarks in which clinicians
talked about themselves .
Other comments included derogatory
statements about the general quality of
hospital care (8) and derogatory remarks
about patients (5).
Physicians were involved in 15 of the
comments, nurses in 10, and other hospital
employees in the remainder.

Conclusion:
Inappropriate comments took place
with disturbing frequency in the
elevator rides.
These comments did not exclusively
involve violations of patient
confidentiality, but encompassed a
range of discussions that health care
employees must be careful to avoid.

 Discuss patient information only with

appropriate staff.
Do not leave messages regarding
patient conditions or test results on
answering machines or with anyone,
other than the patient.

Safety of patients manual and

electronic records:
Do not keep a copy or make copies of
patient information
Donot leave patients medical
records unattended where others can
see it.
Proper disposal of patients
medical information

 When finished looking at electronic

PHI log off the system.
Do not leave information
visible on an unattended
computer monitor.
Keep your passwords safe, donot
share it with others.

Know your limits:

Never assume you have the right to
look at any type of health
information unless you need it in
order to do your job.
Know your expected limits: Check
your job description.

Be responsible:
Hold your colleagues as accountable
as you hold yourself when it comes
to respecting patient privacy.
Practice care that is private and
behavior that guards confidence.
Be a privacy mentor to nursing
students just starting out in the
profession.

 Stand up to peer pressure when

friends or neighbors ask you to do a
favor by obtaining for them copies of
their records or copies of a family
member's records. Always get
written authorization and follow
proper procedure.
Report to your supervisor.

Potential Consequences of Violation

of breach of confidentiality:
Legal consequences
Civil or criminal penalties
Fines plus imprisonment
Professional consequences:
Disciplinary action by the Board of Nurse
Examiners
Academic consequences:
Reprimands
Loss of points toward grade or failure of course
Dismissal from School of Nursing

The Confidentiality Model

PROTECT

IMPROV
E

INFORM

PROVIDE
CHOICE

Protect Patient Information

Procedures to ensure that all staff, are fully
aware of their responsibilities regarding
confidentiality
Recording patient information accurately
and consistently
Keeping patient information private
Keeping patient information physically
secure
Disclosing and using information with
appropriate care.

Inform Patients
Effectively
Check that patient confidentiality and
information disclosure have been read and
understood.
Make clear to patients when information is
recorded or health records are accessed
Make clear to patients when they are or will
be disclosing information to others
Check that patients are aware of the choices
available to them in respect of how their
information may be disclosed and used

CONTD
Check that patients have no
concerns or queries about how their
information is disclosed and used.
Answer any queries
Respect the rights of patients and
facilitate them in exercising their
right to have access to their health
records.

Provide Choice to Patients

Ask patients before using their
personal information.
Respect patients decisions to restrict
the disclosure or use of information,
except where exceptional
circumstances apply
Communicate effectively with patients
to ensure they understand the
implications of their decision.

Improve Wherever
Possible
Be aware of the issues surrounding
confidentiality, and seek training or
support where uncertain in order to
deal with them appropriately.
Report possible breaches or risk of
breaches.

Protecting Patient Privacy and

Confidentiality Can Be A Challenge

Fax machines
e-mail and other computer networks
Electronic records
Telephones and voice mail systems

Laws related to
confidentiality:

Healthcare agencies and providers

must provide confidentiality and
privacy of the healthcare information
that they collect, maintain, use,
and/or transmit. Confidentiality
means that only certain individuals
will have the right to access the
information and that it is secure from
others.

 Patient's Bill of Rightsis a

statement of therights to which
patients are entitled as recipients
of medical care.
Typically, a statement articulates
thepositive rightswhich doctors and
hospitals ought to provide patients,
thereby providing information,
offering fair treatment, and granting
themautonomyover medical
decisions.

Joint Commission on Accreditation of

Healthcare Organizations (JCAHO):
This national organization accredits
health care facilities that meet JCAHO
standards. Patient confidentiality and
privacy is an important part of these
standards.

National Committee for Quality

Assurance (NCQA):
Is an independentnon-profit
organizationin the US designed to improve
health care quality.
It manages voluntary accreditation
programs for individual physicians, health
plans, and medical groups.
It had developed special recommendations
to help managed care organizations
protect patient privacy and confidentiality.

Conclusion:
Patient confidentiality and privacy
are a very important aspect within
our jobs in the healthcare industry.
Maintaining confidentiality will
ensure quality care .
Also legal issues are on rise these
days.

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