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Advice P.R.N.

doi: 10.1097/01.NURSE.0000547732.97426.b3
Department: Advice P.R.N.

Who should seek medical advice before receiving the flu vaccine?...how to apply the HIPAA Privacy Rule during a natural disaster...legal implications for nurses who sign a patient's document as a witness

Nursing2018 will seek professional advice on any reasonable question related to nursing. Send queries to Michael Jones, Nursing2018, Wolters Kluwer, Two Commerce Square, 4th floor, 2001 Market St., Philadelphia, PA 19103, or send an e-mail to Michael.D.Jones@wolterskluwer.com with “Advice” in the subject line.

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INFLUENZA VACCINE

Should pregnancy give you pause?

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I know the CDC advises nearly everyone age 6 months and older to get the seasonal influenza vaccine. For safety, should pregnant women or people with preexisting medical conditions get a prescription from their healthcare provider to receive a vaccine in a nonmedical setting, such as their workplace?—L.M., N.C.

The CDC has made no recommendation that pregnant women or people with preexisting medical conditions seek special advice or obtain a prescription from their healthcare provider if they get vaccinated at a worksite clinic, pharmacy, or another location besides their physician's office. However, the CDC does recommend that people seek medical advice before vaccination if they have a fever or are not feeling well, if they have a history of Guillain-Barré syndrome, or if they are allergic to any vaccine component.

Many influenza vaccine products are available for this flu season. Vaccine providers should be aware of the approved age indications of the vaccine they are using and of any contraindications or precautions. Providers also should appropriately screen all people getting vaccinated for allergies to vaccine components or other contraindications. People who have previously had a severe allergic reaction to influenza vaccine or any of its ingredients should generally not be vaccinated.

CDC urges people to get a flu vaccine by the end of October, but getting vaccinated later is still beneficial. Starting on December 2, CDC promotes National Influenza Vaccination Week to highlight the importance of continuing flu vaccination through the holiday season and beyond. For more information about this flu season, visit www.cdc.gov/flu/about/season/health-care-professionals.htm.

Sources: Centers for Disease Control and Prevention. Misconceptions about seasonal flu and flu vaccines. www.cdc.gov/flu/about/qa/misconceptions.htm. Frequently asked flu questions 2018-2019 influenza season. www.cdc.gov/flu/about/season/flu-season-2018-2019.htm. National Influenza Vaccination Week. www.cdc.gov/flu/resource-center/nivw/index.htm.

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NATURAL DISASTERS

Does the HIPAA Privacy Rule still apply?

Last October I was involved with hurricane disaster relief efforts in Florida. In my hospital job, I'm very careful not to violate the privacy provisions of the Health Insurance Portability and Accountability Act (HIPAA). But do the same rules apply during a natural disaster, when normal services and lines of communication aren't functioning?—A.S., FLA.

Although the HIPAA Privacy Rule is not suspended during a natural disaster, hospitals may not be penalized for certain violations if the President declares an emergency or disaster and the Secretary of Health and Human Services (HHS) declares a public health emergency. In that case, the Secretary of HHS may waive sanctions and penalties against a covered hospital for failure to comply with these Privacy Rule provisions:

  • the requirement to obtain a patient's agreement to speak with family members or friends involved in the patient's care
  • the requirement to honor a request to opt out of the facility directory
  • the distribution of a notice of privacy practices
  • the patient's right to request privacy restrictions
  • the patient's right to request confidential communications.

These waivers apply to hospitals that have instituted a disaster protocol and cover all patients at those hospitals for up to 72 hours from the time the disaster protocol is initiated. When the Presidential or Secretarial declaration terminates, hospitals must then comply with all the requirements of the Privacy Rule for any patient still in their care, even if 72 hours has not elapsed since the disaster protocol was implemented.

Regardless of whether an emergency waiver has been activated, the HIPAA Privacy Rule permits disclosures for treatment purposes and certain disclosures to disaster relief organizations, such as the American Red Cross. For more information about HIPAA requirements and waivers, visit www.hhs.gov.

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DOCUMENTATION

Signing up for trouble?

At a patient's request, I witnessed the signing of a legal document. Later, I began to worry about signing my name as a witness given that the patient's family dynamics are somewhat contentious. What are the legal implications for me if it turns out that the patient was coerced into signing this document?—C.L., MD.

When you sign as a witness, you are usually certifying only that you saw the person, known to you by a certain name, place his or her signature on the document. You are not necessarily certifying the presence or absence of duress, undue influence, fraud, or error. Similarly, when you witness an informed-consent document, you are not validating that the patient has been told the significant risks, benefits, and options for treatment, which constitutes informed consent. When you witness consent forms in a nursing capacity, your signature merely attests to the signer's authenticity, voluntariness, and capacity.

If an allegation of fraud goes to court, however, you could be an important witness. An RN with a professional level of assessment expertise whose function is, in part, to continually assess a patient's mental status could be questioned about the patient's mental capacity, undue influence, and duress. In court or at a deposition, you may be asked to describe the patient's interactions with his or her family, attorney, and others. A court looking into charges of fraud or undue influence used in executing a document will usually give great weight to a nurse's testimony.

Source: Iyer P. Legal aspects of documentation. In: Ferrell KG, ed. Nurse's Legal Handbook. 6th ed. Philadelphia, PA: Wolters Kluwer Health; 2016:266.

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