Surveyors take issue with patient flow boards
Patient flow boards are hot topics with JCAHO surveyors who want to see that patient confidentiality is protected. "They are big on privacy issues and really scrutinize flow boards and how they are used," says Judy Maupin, MSN, RN, CNAA, senior advisor of clinical services at Columbus Regional Hospital. "You need to be able to explain how you have gone about protecting confidentiality." Still, clinicians need easily accessible information about patients, she notes. Here are some solutions to protecting patient confidentiality on flow boards.
Put flow board out of public view. If the patient's full name and diagnosis are there, the flow board cannot be in a public place, says Maupin. "It's OK if it's hidden from traffic, like in a medications room. If it's in a work room where only staff have access to it, they consider it protected, but it can't be out in the hallways," she explains.
Avoid using patient's last name. At Columbus Regional, the patient's first name and last initial are used on the flow boards. "We didn't have any area like a work or medicine room that would be user-friendly for the staff, so we had to eliminate part of the patient's name," says Maupin.
Since the flow board is in the hallway, the patient's name can't be associated with their medical condition. "The criteria is, could someone go up to that board and know who the patient is, and what is wrong with them?" says Maupin. "We also use more of a symptom than a diagnosis. If somebody comes in with chest pain, their chief complaint is recorded, not whether they have pneumonia or an MI."
Use screen shields. If the tracking board is computerized, screen shields can help conceal confidential information. "With the shields, you can only see it if you're directly in front of the screen, and you can't see it from any other angle," says Maupin.
Obtain consent. At Children's Hospital of Birmingham (AL), the ED clinicians chose to keep the patient's name and chief complaint on the flow boards. "As a teaching facility, our physicians wanted to allow discussion of the cases before entering the room, and felt they could not give that up," says Barb Pierce, MS, RN, divisional director of emergency services at Children's Hospital. When parents come in, they sign a consent form which says their child's name and chief complaint will be used on a flow board for teaching purposes.
When the ED was surveyed last March, surveyors said the system was acceptable. "They felt it was fine, as long as we had documentation of the discussions that took place about why we felt we needed this policy, including minutes from the meetings when physicians talked about it," says Pierce.
EMS codes. At Medical University of South Carolina's ED, EMS categories are used instead of words on patient flow boards. (See chart, opposite page.) "The staff has gotten used to it rapidly, since we use a lot of those codes to begin with," says Mary Anderson, RN, BSN, nurse manager of emergency services. Additional codes were added for complaints that didn't fit into existing EMS categories.
If a staff member is unsure of a numerical code, there is a "cheat sheet" on the patient's clipboard. "It's underneath all the patient information so it's not visible to anybody," says Anderson. Small cards were made for the back of nurse's name badges and physicians' pockets for quick reference.
Alphabet code. When Scottsdale Memorial Hospital/Shea (AZ) was reviewed by the Joint Commission, the reviewers advised the ED staff that having the patient's name on flow boards in full view of other patients was problematic. "We always liked to have the patient's last name, but Joint Commission said that was unacceptable since our flow board is visible to other patients, visitors, and ancillary staff," says Pamela Sullivan, RN, pre-hospital coordinator and patient care council for the ED.
The ED's patient care council devised an alternative method of using alphabet letters to stand for chief complaints. (See the alphabet code, opposite page.) "At first, we tried using a number for the chief complaint, but the nurses and physicians felt it was too difficult to memorize all the different numbers," says Sullivan. "The alphabet system is an easy way to let everyone know what is going on with each patient in a discreet manner. Staff learned the abbreviations quickly because they are easy and logical." Appropriate combinations are used, such as "P/F" for a child with a fever.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content