Laboratory access:
when to withdraw the welcome mat
Q Currently, there is a stream of visitors in the work area of our laboratory, including couriers from reference labs, sales reps, family members, employees just visiting from other departments, union representatives, and so on. Is there some statute or rule that limits the number and type of visitors or that prohibits certain visits? What about the lack of privacy of patient information displayed on computer screens? What about the liability of the hospital by allowing visitors in a potentially contaminated area? Administration seems to accept the status quo, but I am not sure administrators understand the nature of the problem.
A Ultimately, the policy decision about limiting visitors to the lab is one to be made by administration, but certainly laws and principles exist that must be taken into account when drawing up a reasonable and enforceable set of visitation rules. protection of patient privacy must be one of the foremost concerns, but safety, security, and productivity must also be taken into account. To present a suggestion for improving control of visitors in laboratory areas, start by documenting who is visiting and for what reason, as well as the effects of the visit.
HIPAA and other privacy regulations make it incumbent upon laboratories to maintain appropriate security for patient records and ensure confidentiality of patient information. This is more difficult to do when visitors frequent areas in which patient records are stored, created, or managed. Hospital employees present relatively little concern, as they should all be subject to confidentiality policies in the hospital, but outsiders should be kept away from sensitive areas and patient information. it may be necessary to secure confidentiality agreements where there is access to patient information. Also, make certain simple things are done to protect information, such as locking cabinets, using number identifiers, and placing polarized filters on computer screens to prevent accidental viewing of patient records.
Keep in mind that the rights of union representatives to meet with members, though not unlimited, are protected under both law and collective bargaining agreements. any restrictions on union representatives should be cleared through your hospital attorney. providing access to their members and an appropriate room in which to meet should be sufficient. Because the relations between unions and institutions can be acrimonious, it is important that both legal advice and the input of union members regarding their real needs, be sought. In general, union representatives will have no reason to access patient information and should be restricted from being able to do so.
Security of the lab is compromised whenever visitors flow through the work area. If there is no control or challenge for identifying those who are not laboratory personnel and who do not belong in an area, it is too easy for outsiders to gain access to the lab and compromise the workplace. Patient records or laboratory supplies can be stolen, computers can be hacked, and biological specimens contaminated, switched, or waylaid for nefarious purposes.
Safety is a concern as the lab contains many hazards. Visitors not familiar with lab safety are at risk and if injury occurs, the institution may be liable.
Finally, uncontrolled visitors tend to disrupt workflow. The noise and chatter they create is often the very aspect that actually prompts the limitation of lab visitors. When laboratory personnel are interrupted by others, testing errors, as well as greatly reduced productivity, can result. Some labs prohibit nearly all visitors in testing areas; some even screen telephone calls to reduce interruptions.
After you have documented the number of visitors and their effect on productivity, drafting rules restricting transit through the lab becomes a relatively simple matter. Visitors with no business relative to the function of the laboratory should, in general, be prohibited. This includes family and friends even other hospital employees. Couriers, repairmen, and support staff should have access as needed, but should be instructed not to interrupt lab work flow and to maintain patient confidentiality.
It might be reasonable to create an access point where visitors are cleared with appropriate limitations. An escort may be assigned to ensure these limitations are respected. Some institutions require temporary guest badges a simple way for staff to recognize those who have gained access.
There is no single, simple answer, but attention to the underlying concerns of patient care and institutional integrity, coupled with an assessment of what your problem really is, will provide the basis for a workable visitation policy not only for the laboratory but also for the hospital as a whole.
Barbara Harty-Golder is a pathologist-attorney consultant in Chattanooga, TN. She maintains a consulting law practice with a special interest in medical law. She writes and lectures extensively on healthcare law, risk management, and human resource management.
January
2004: Vol. 36, No. 1©
2004 Nelson Publishing, Inc. All rights reserved.
