Posting About Your Residents on Social Media Violates More Codes Than You Could Ever Imagine | Joint Commission
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Tuesday 5:44 CST, May 23, 2017

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Quality in Nursing Center Care

RSS Feed RSS By: Gina Zimmermann, M.S., Executive Director, Nursing Care Center

A blog for and about The Joint Commission’s Nursing Care Center Accreditation Program.

Posting About Your Residents on Social Media Violates More Codes Than You Could Ever Imagine


May 17, 2017 | 761 Views

Amid shocking new realities like broadcasted rapes and a Facebook Live murder, debate on how to address malicious use of social media is rightfully underway.

The nursing home industry is not immune. News stories are surfacing about nursing home patients and residents being photographed for Snapchat and other social media outlets covered in their own feces, getting ready for the shower or engaged in sexual relations. The images are appalling, and only humiliate vulnerable patients and residents served in nursing homes. 

For many years, these acts pre-dated any laws on patient violations. That is quickly changing. Last year, the Centers for Medicare & Medicaid Services (CMS) began reviewing nursing homes’ policies regarding staff members violating patient rights on social media.

The Joint Commission is strongly urging all organizations including nursing homes to draft a social media abuse policy and train employees accordingly. 

Geriatric Abuse Assessment Violation
Know that The Joint Commission considers social media abuse a violation of PC.01.02.09, EP1. It’s essential that we assess and re-assess our patients and residents for any possible indication of mistreatment on social media as judiciously as we would for:

  • physical abuse
  • sexual, abuse
  • domestic abuse, or
  • any other form of abuse, neglect, or exploitation

In addition to this EP, PC.01.02.09 EP 3 states: “The organization educates staff about how to recognize signs of possible abuse, neglect, and exploitation, and about their roles in follow-up, including reporting. (See also HR.01.05.03, EP 5). Staff should educated by the facility on what constitutes:

  • abuse
  • neglect
  • exploitation
  • individual responsibility to report.

Video recording without consent opens an organization up to non-compliance allegations and raises questions about reporting requirements for abuse, neglect and exploitation. The Leadership chapter of The Joint Commission Accreditation Manual, specifically LD.04.01.01 EP 2, and the Information Management chapter IM.02.01.01, EP 3 speaks to sharing of health information only for purposes permitted by law and regulation.

Lastly, organizations are expected to have an organization-wide, integrated patient and resident safety program. Leadership is responsible for providing and encouraging the use of systems for blame-free internal reporting in LD.04.04.05, EP6. Staff must feel safe to report any abuse, neglect or exploitation that they witness in order to have a true culture of safety. (Learn more about the importance of blame-free reporting as one of the 11 tenets of safety culture in this blog.)

Marketing Materials Infringement
When a patient or resident is admitted into a nursing home, it is standard policy to present a document affirming that it’s acceptable to take and use photographs in facility’s marketing materials. This does not, however, extend to capturing patient or resident images for a staff member’s personal social media feed, even with the purest intent. (Yes, it does happen that staff member post a resident photo in a positive capacity, thinking this is admissible.)

The Joint Commission requires facilities to seek informed consent when residents are photographed or videotaped for external distribution under RI.01.03.03, EPs 1 and 2. This mandates an explanation of how the materials will be used. Under no circumstances is it ever acceptable to \ patient or resident images obtained for publicity purposes into memes.

Acknowledging HIPPA
Clinical and non-clinical staff are trained extensively on HIPAA regulations, and there is nothing that can be justified as suitable for posting about a patient or resident without authorization.
In 1996, HIPPA was enacted, ensuring data privacy and provisions for safeguarding patient medical information, including:

  1. names
  2. addresses
  3. all elements of dates (except year) directly related to an individual
  4. phone numbers
  5. fax numbers
  6. electronic mail addresses
  7. Social Security numbers
  8. medical record numbers
  9. health plan beneficiary numbers
  10. account numbers
  11. certificate/license numbers
  12. vehicle identifiers and serial numbers, including license plate numbers
  13. device identifiers and serial numbers
  14. web Universal Resource Locators (URLs)
  15. Internet Protocol (IP) address numbers
  16. biometric identifiers, including finger and voice prints
  17. full face photographic images and any comparable images; and
  18. any other unique identifying number, characteristic, or code (note this does not mean the unique code assigned by the investigator to code the data)

On social media, many people fall into the pitfall of thinking that anonymous photos of patients or residents don’t fall into any of these categories. However, if you showcase a face combined with the name of the facility without a HIPPA-compliant authorization, it’s considered a HIPPA violation.

This stands even when the patient has offered verbal or written (non-HIPPA specific) consent. Even when the offending staff member doesn’t list the facility name on his or her social media profile, it can still be discovered with a simple Internet search of staff’s name or comments about where the staff member is working, or the geographical area and, therefore, may still be a HIPPA violation.

It’s also common for violators to think they won’t be caught. While that may have been the case in the dawn of social media, times have changed. In fact, the Health and Human Services Office for Civil Rights already opened investigations of breaches affecting 500 individuals and more will surely follow.

Implications are far-flung in each and every one of these cases. Individual offenders can suffer significant penalties with an intentional violation of the law.  For the nursing home, consequences can be severe, encompassing:

  • adverse licensure actions
  • civil monetary and/or penalties from $100-$50,000 per violation per day
  • sanctions by federal and state regulatory authorities
  • trigger of the HIPPA Breach Notification Rule

It’s worth your time to train your staff on the dire consequences to ill-conceived publishing on social media. The wrong kind of post can not only end up costing your organization a great deal of money—it’s also harmful and degrading to our patients and residents.     

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