SAN ANTONIO REGIONAL HOSPITAL

Report ID: N2RB11.01, California Department of Public Health

Reported Entity: SAN ANTONIO REGIONAL HOSPITAL

Issue:

Based on interview, and record review, the facility failed to ensure the confidential treatment of protected health information (PHI), when Patient A was inadvertently provided Patient B's prescription upon discharge. This resulted in a breach of PHI.Findings:An unannounced visit was made to the facility on January 23, 2014 at 8:45 AM, to investigate an entity reported incident of a breach of PHI for Patient B.During an interview with the Director of Nursing Operations on January 23, 2014 at 9:15 AM she stated, "On January 3, 2014, two (2) patients were being discharged from the emergency room. The registered nurse (RN 1) inadvertently gave Patient B's after care instructions and prescriptions to Patient A. Patient A was being seen for chest pain, and Patient B was 21 weeks pregnant, and had chest tightness. The error was discovered by the pharmacy."A review of the after care paperwork provided in error to Patient A, included:Patient B's name, age, gender, account and medical record numbers, diagnoses and doctor's name and address. The prescription contained the patient's name, date of birth, physician's name and the medications with dosages.A review of the facility policy and procedure titled, "Confidentiality, Protecting Confidential Information,"July 2012, indicated, "Confidential information must be protected from unauthorized uses, disclosures..."During an interview with Director of Nursing Operations on January 23, 2014 at 10:00 AM, she stated, "The nurse [RN 1] did not check the name before providing the instructions or the prescriptions to Patient A." She confirmed a breach had occurred.

Outcome:

Deficiency cited by the California Department of Public Health: Patients' Rights

Related Reports:

1 other violation reported on the same date. Note that other citations may be about the same event: 81HS11.01