[utahliz]

I'm a new grad just licensed but on orientation, and was told something today that I'm wondering about.

In all my clinicals, the nurses updated family members designated by the patient as able to receive information. Never once was I told that it was a HIPAA violation or a violation of the Nurse Practice Act to inform a family member of a patient's condition when the patient consented.

Today, my patient was becoming increasingly stuporous and at lunch I asked an experienced nurse if there was anyplace in the chart where it was noted whom the patient had designated to receive health information.

She replied that nurses were never, under any circumstances, permitted to provide health information to anyone, no matter what the patient's wishes were, that in fact we could lose our licenses for doing so, and that only physicians are permitted to do that.

This is the first I've heard of this. Is it correct? Are the multitude of nurses risking their licenses by such communication? If so, why do we bother to ask the patient for consent to have such communication?

Beth

[thatoneguy]

Originally Posted by utahliz

This is the first I've heard of this. Is it correct? Are the multitude of nurses risking their licenses by such communication? If so, why do we bother to ask the patient for consent to have such communication?

Beth

good question. i think it is ok to tell a family member about certain procedures or what the patient has, like cancer, and the disease process, if the patient consented to it. but telling a patients family or even the patient about his/her specific condition and what it means is up to the doctors.

[jimthorp]

Where I work we have in the front of every patient's chart a face sheet. Amoung other information is the patient's designated contact information. When something out of the ordinary occurs with a patient such as a fall we must notify someone on that list as well as the PCP.

[grinnurse]

We don't really have a "consent" form to sign saying who we can or cannot release information to at this time other than as one stated. I never give out information about the patients condition over the phone period unless they can give the code word but that information only consist of answering questions such as: has the condition changed, did they sleep through the night, did they rest, etc. Now, if the patient asks me information on a specific test that was run, I do not give the information b/c it is for the Doc to interpret the test or how a surgery went. If a person that is standing in the room asks for information, I get verbal permission from the patient to give the information or I will give information to another person if the patient asks me to repeat it to usually a dau. or son. I only divulge information on lab values from blood draws and how that might be affecting the patient to the patient. I find myself teaching quite a bit about the disease process and how the lab values of certain things affect other aspects of the body which is within the scope of NPA.

Maybe the difference that you are seeing is in the terminology of "condition" vs "diagnosis". Don't know though but I find it best to let the Doctor do most of the informing to the patient and to the family. About the 2nd week of being on my own, a patient asked me what a particular test was for and it happened to be for syphillis and he says what makes him think I've got that? My reply was that b/c he had other signs and symptoms ie., the oozing leasions on his penis, etc. might be why. That guy got so mad at me he left AMA with the HL still in. I litterally was talking to him out on the bench trying to get him to let me at least get the HL and to sign the papers. He proceeded to remove it himself. Come to find out, he was positive for syphillis. We were always taught in NS to be honest with the patients. Just one more way that NS is totally different from the real world of Nursing

[Daytonite]

This HIPAA stuff is just so much a PIA. I've been in nursing for 30 years and wouldn't hesitate to make a phone call to whoever the patient had indicated during his admission as a contact person for him. Now, everyone is worried about HIPAA violations. What are they going to do, throw you in jail for making a phone call, especially when you've checked the chart or asked the patient to find out who to call? Honestly, if it were your dad lying in that bed, would you want to hear a bunch of crap about HIPAA as the reason you didn't get called when daddy was circling the drain? Hospitals have carried this HIPAA confidentiality on the nursing units way out of proportion. HIPAA was initially designed to deal with the paperwork, mandatory reporting to Medicare, and third party insurance payers. Somehow, some people got panicy and worried about calling relatives. I'm not saying that it can't happen that there's someone the patient doesn't want knowing about them, but in my experience the patient is usually yelling about that as they are being admitted. I worked on a unit where we occassionally had people who wanted their identity hidden and we had procedures in place to do just that.

OK, let me get off my platform now. Go to the nurse educators and ask them about hospital HIPAA policy. Or, check the nursing policy manual on this. Read it over and follow it to the letter. Follow what is said in black and white. You can't go wrong that way. That aside, I would say, use common sense. Develop some kind of a relationship with your patients and find out who they live with, who cares for them, who will want to know about them. That way, if something does go wrong with the patient, like me, you won't feel the least bit hesitant about who to call. It so bothers me that a lot of newer nurses are so willing to remain distant from their patients and the patient's family because they were admonished against doing this in nursing school rather than establish some kind of relationships with their patients and families. Families are part of our patient's lives and it is wrong to ignore them. Geez!

[utahliz]

Thanks for all the responses. I asked around yesterday in my orientation class and today when back on the floor, getting a variety of answers. Let me clarify that I wasn't providing a diagnosis or info over the phone, in fact I was just asking about how to handle the situation when a patient went from A&O to somnolent and/or not oriented. The nurse who lectured me last week is quite experienced but somewhat dissatisfied and has obviously been burned. I knew from past experience that there is some suspicion about people being who they say they are over the phone, but then I've also witnessed situations where people are present in person and falsely claim to be family. Our hospital appears to be moving toward implementing PIN numbers for patients to give out to those whom they authorize to receive updates, which addresses my original concern. I didn't know I was uncovering such a hornet's nest.

Beth