VA Great Lakes Health Care System (VISN 12)

Report ID: SPE000000058647, U.S. Department of Veterans Affairs

Reported Entity: VISN 12 Madison, WI

Issue:

A log book is missing from the locked room where it was stored. Update: 03/16/11:On February 21, 2011, an Ambulatory Surgery log book containing full patient name, full SSN, DOB, surgery follow-up, and the lot number of the specific pill-cam (pill camera) used during procedures was accidentally knocked in the trash when a refrigerator was moved to gain access to an emergency electrical outlet. Multiple searches for the log book in the secure medication room did not find the log book. The log book contained patient information from January 2008 until February 2011 of 117 unique Patients. Due to a misclassification of the issue by the facility Privacy Officer (PO), the incident was not reported to Risk Management and Incident Response (RMIR) until March 16, 2011. Therefore 117 Patients will receive a letter offering credit protection services. (report of contact is attached to the ticket).3/30/11:Two duplicates found. 115 patients will receive a letter offering credit protection services.

Outcome:

We have not been able to locate the log book. Staff believes it fell into the wastebasket; however, trash compactor was cleared out before Privacy Officer and VA Police were notified of the incident. We are in the process of eliminating all hard copy log books by converting them to electronic form. Staff has been reminded of proper security policies and procedures and re-educated on the necessity of maintaining awareness and confidentiality of patient information.

Related Reports:

1 other violation reported on the same date. Note that other citations may be about the same event: SPE000000058637