HIPAA REGULATIONS
Dust off those files
I work in a healthcare provider's office. A former patient has asked for access to her healthcare records dating back to 1986 as mandated by the Health Insurance Portability and Accountability Act (HIPAA). The provider says we can probably find them in our archives but we are not obligated to provide them to her because they predate HIPAA's enactment into law in 1996. Is he correct?-N.R., MINN.
No. According to the US Department of Health and Human Services, a patient has the right to his or her own records "regardless of the date the information was created or whether the information is maintained onsite, remotely, or is archived."1 This assumes that the provider is a covered entity, defined in part as a provider of healthcare services who furnishes, bills, or is paid for healthcare in the normal course of business.2 A covered entity can deny patients access to their medical records only in very limited circumstances, and these "do not include the age or location of the information."1
REFERENCES
1. US Department of Health and Human Services. Category: HIPAA. http://www.hhs.gov/answers/hipaa/index.html. [Context Link]
2. US Department of Health and Human Services/National Institutes of Health. To whom does the privacy rule apply and whom will it affect? https://privacyruleandresearch.nih.gov/pr_06.asp. [Context Link]
VINCA ALKALOIDS
Just say no to syringes
VinCRIStine, a vinca alkaloid that must be administered I.V., was prescribed for a pediatric patient on my unit to treat acute lymphocytic leukemia. In most cases, my facility's pharmacy dilutes and dispenses this drug in an I.V. minibag, but on this occasion, the pharmacy provided the patient's dose in a syringe.
Because I have heard of patient deaths that occurred when vinCRIStine was inadvertently administered by the intrathecal route, I asked the clinical pharmacist whether the drug should always be provided in an I.V. minibag to prevent such a catastrophic error. He agreed that dispensing the drug in a minibag would be safer but pointed out that the prescribing information also provides directions for dispensing it in a syringe. Is this a safety issue, or am I overreacting?-A.R., TENN.
You are right to be concerned about the risk for a wrong-route error when a patient has both an I.V. and an intrathecal catheter in place. In 2019, at least four children died following inadvertent administration of a vinca alkaloid by the intrathecal route.1 According to the Institute for Safe Medication Practices (ISMP), administration by syringe was at the root of all these errors.2 ISMP estimates that clinicians in 15% to 20% of US hospitals administer vinca alkaloids via syringe at times, primarily for pediatric patients.2
To avoid the risk of confusing vinca alkaloids with intrathecal medications provided in syringes, ISMP has asked the FDA to remove instructions for administration of vinca alkaloids by syringe from the prescribing information. This initiative is strongly supported by The Joint Commission and the National Comprehensive Cancer Network.1
Hospitals should make it a policy to always dilute and dispense vinca alkaloids in an I.V. minibag. Talk with your manager about establishing this as a best practice at your hospital.
REFERENCES
1. Institute for Safe Medication Practices. ISMP calls on FDA-no more syringes for vinca alkaloids! Acute Care ISMP Medication Safety Alert. March 14, 2019. [Context Link]
2. Institute for Safe Medication Practices. Start the New Year off right by preventing these top 10 medication errors and hazards. Acute Care ISMP Medication Safety Alert. January 16, 2020. [Context Link]
PATIENT SAFETY
Do sitters prevent patient falls?
On the medical/surgical unit where I work, we try to assign volunteers as "sitters" to help protect patients at risk for falls. Is this an evidence-based practice?-M.L., WASH.
Providing sitters, also called safety companions, seems like common sense, yet surprisingly little research has been done to examine their effectiveness in reducing patient falls. With support from the Veterans Affairs Quality Enhancement Research Initiative, researchers recently published a literature review on this issue.1 They looked at English-language studies that assessed the effect of adding sitters to usual care or compared alternatives to sitters, such as video monitors or "close observation units." Findings were based on 20 studies involving adult patients on general units in acute care hospitals that reported falls as a primary outcome.
Two studies found that adding sitters reduced falls, but the evidence was termed "very-low-certainty." Eight studies provided moderate-certainty evidence that interventions such as video monitoring reduced use of sitters but had little or no effect on fall rates. Several studies suggested that interventions such as nursing assessment tools and close observation were effective alternatives to sitters, but this evidence was also described as "very-low-certainty."
The researchers write that "despite the lack of evidence, the rationale for the use of sitters to prevent falls is compelling, and it seems premature to conclude that their use should be abandoned." However, they conclude that based on evidence from currently available research, the effect of sitters on fall risk is modest at best. Clearly more research is needed.
REFERENCE