Lecture Notes: Advance Directives and HIPAA

Summary

In this lecture, the focus was on advance directives and the Health Insurance Portability and Accountability Act (HIPAA). The key points covered include different types of advance directives like living wills, Do Not Resuscitate (DNR) orders, and durable power of attorney. The lecture also detailed the fundamentals of HIPAA, emphasizing the importance of maintaining patient privacy and the correct protocol for discussing patient information.

Advance Directives

Advance directives allow patients to make decisions about their healthcare in advance, particularly in scenarios where they might be incapacitated.

Patient Self Determination Act

• Legally ensures patients can make their own healthcare decisions, establishing the principle of autonomy.

Types of Advance Directives

1. Living Will

   • Allows patients to specify the medical interventions they prefer or refuse in case they're incapacitated.
   • Example directives: preferences concerning intubation, tube feedings, etc.

2. Do Not Resuscitate (DNR) Orders

   • Indicates that no resuscitative actions should be taken in the event of cardiac death.
   • Requires to be familiar with state-specific DNR variations.
   • Must have a Physician Orders for Life-Sustaining Treatment (POLST) form completed.

3. Durable Power of Attorney

   • Authorizes another person (not necessarily a relative) to make medical decisions on the patient's behalf when they are unable to do so.
   • Exclusively covers medical decisions.

Health Insurance Portability and Accountability Act (HIPAA)

HIPAA protects the privacy of a patient’s medical records and sets standards for the secure handling of health information.

Key Provisions

• Healthcare providers can discuss a patient’s condition within the healthcare team directly involved in the patient’s care.
• Disclosure of information to parties not involved in care or without patient consent is forbidden.
• Spouses or family members may receive information only if the patient has authorized this explicitly.

Best Practices for Maintaining HIPAA Compliance:

1. Communication

   • Discuss patient information only in secure locations and only with those directly involved in providing care.
   • Avoid discussing patient information in public areas like cafeterias or elevators.

2. Electronic Health Records (EHR)

   • Utilize strong, unique passwords and change them regularly.
   • Never share these passwords, even with supervisors.
   • Always log off from systems when stepping away, even for short periods.
   • Access only those patient charts that you are directly involved in managing.

Breaches and Accountability

• Report any breaches of confidentiality, intentional or accidental, to a direct supervisor.

Conclusion

Understanding and implementing advance directives, as well as adhering to HIPAA regulations, are crucial aspects of nursing. These practices ensure patient autonomy and confidentiality, two fundamental rights in healthcare.

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The lecture concluded with an emphasis on the significance of understanding these topics thoroughly for both practical application and examination purposes. The next topics to be addressed in lectures include intentional and unintentional torts and mandatory reporting.