Failure to Safeguard Resident Medical Record Confidentiality
Penalty
Summary
The facility failed to maintain the confidentiality of resident medical records for three out of five sampled and supplemental residents. Facility policy requires that protected health information (PHI) in any form remain confidential and that care be taken to ensure privacy when handling such information. Despite this, observations revealed that an LPN repeatedly left a medication cart in the hallway with the computer screen displaying residents' medical records unattended. This occurred multiple times while the LPN was administering medications to different residents, leaving their PHI visible to staff passing by in the hallway. Specific incidents included the LPN leaving the computer screen open with individual residents' medical records displayed while entering residents' rooms to administer medications. On several occasions, other staff members walked past the unattended cart with the open screen. The Nursing Home Administrator confirmed that employees are expected to safeguard PHI and close or lock computer screens when left unattended, but this expectation was not met during the observed events.