Access to Nurse via Telephone

[Flying ICU RN]

Here is a question that I have for administrative types and or policy makers,...

Why does anyone outside of the hospital and not a provider have access to me via telephone?

From the HHS.gov website, (see underlined)

Protected Health Information. The Privacy Rule protects all "individually identifiable health information" held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. The Privacy Rule calls this information "protected health information (PHI)."12

“Individually identifiable health information” is information, including demographic data, that relates to:

• the individual’s past, present or future physical or mental health or condition,
  

If I am a covered entity, then why are administrative clerks or anyone else for that matter, relaying calls of inquiry regarding a patient to me at all? I should never have to come to the phone.

[Esme12, ASN, BSN, RN]

Sounds like somebody's annoying you!!!!!!

[Flying ICU RN]

Sounds like somebody's annoying you!!!!!!

Bingo!

A long term clerk with a screeching voice who bellows out, "Telephone for the Nurse for Bed five!" Only to come to the phone to find out it's the sixth consecutive "old friend" from Kalamazoo in the past hour.

Since the clerk is under the same "covered entity" rule, it's much easier to let the Nurse deal with the disgruntled public you see.

However, I assume it's not the clerks that are making all of these medical errors that the Institute of Health says is causing thousands of annual hospital deaths.

So the question is a legitimate one of patient safety for administration to address the unpleasant and conveniently dodged reality of "custormer service", yet is an unnecessary distraction for clinical staff to have to contend with in the first place.

In light of the fact that the public is well educated with regard to attorney-client privilege (thanks to TV) but is ignorant of medical privacy issues, I think it the responsibility of Health Care Administrators to insulate clinical staff from this distraction.

[cookienay]

"Now, I know you can't tell me anything because of confidentiality and all that, but what was was wrong with him?"

That is my favorite.

You can bet the clerks hear about it when I get that phone call. I tell them "The patient has a phone in their room. You have a transfer button on your phone. Use it." Ok- maybe not exactly in those words but you get the idea.

[DalmatiaRN]

I have this same issue. All of these calls from random "friends" and "family". I have no way of knowing whom I am speaking with and the questions are always , "How is X doing?" Then this always leads to " Have there been any test results?" What has the doc said?"

How do any of you respond to these? I'm still new and my generalizations I fear come off as insincere, I'm not even sure if I'm allowed to make generalizations. I've asked others where I work and get a basic "use your nursing judgment" answer.

[LACA, BSN, LPN, RN]

In the physician's office I used to work at, if you called and asked to speak with the nurse, you were told you could either leave a message with the receptionist or you could leave a voicemail on our desk phones. There was no option of speaking to anyone directly.

As for what you should do or say when you pick up the phone and realize it's your patient's granddaughter's boyfriend's mom's sewing circle friend calling to check and see how she's doing...I would simply say "Who am I speaking with? How are you related to Mrs. SoNSo? I'm sorry, but I can't give you any sort of information over the phone. You are more than welcome to call directly into her room or contact one of her family members for more information. Thanks for calling to check on her, have a lovely day."

[APRN., DNP, RN, APRN, NP]

I've seen facilities use different methods of ensuring that only the folks with the need to know are able to get to know any information about the patient.

A "pin code" which is short for Personal Identification Number is taken from the last few numbers of a patient's medical record number and given to the people that the patient chooses to release information to.

If a patient's family member calls and requests information about that patient, but they do not posses the right PIN code, they are instructed to either talk directly to the patient, or to the person who has the PIN code.

As for a unit clerk, secretary, ward clerk, monitor tech or what have you.....We don't have one of those where I work. Nursing answers ALL of the calls coming in. Many times, the phone to the unit will just ring, and ring, and ring while me or the other nurses finish our most pressing patient care duties. The caller can call back. I've never heard of any complaints about the phone not getting answered.

[tri-rn]

I transfer them to the patient's room myself, or I'll ask the patient if I can talk to so-and-so about thier condition.

It gets more complicated when the patient is unable to speak for themselves. If the person states they are the patient's wife/child and that person's name is listed as the POA I'll say something like "tell me the last thing you heard and I'll go from there". If they seem informed about the patient's condition I'll go ahead and update them...still no way to know for sure that they are who they say they are, but what can you do? If they aren't claiming to be the person listed as POA, I'll tell them I'm so sorry that I can't give that info to them, but they might try contacting the patient's POA.

I feel terrible for patient's families when I can't tell them what's going on, but I don't write the laws.

[Esme12, ASN, BSN, RN]

Bingo!

A long term clerk with a screeching voice who bellows out, "Telephone for the Nurse for Bed five!" Only to come to the phone to find out it's the sixth consecutive "old friend" from Kalamazoo in the past hour.

Since the clerk is under the same "covered entity" rule, it's much easier to let the Nurse deal with the disgruntled public you see.

However, I assume it's not the clerks that are making all of these medical errors that the Institute of Health says is causing thousands of annual hospital deaths.

So the question is a legitimate one of patient safety for administration to address the unpleasant and conveniently dodged reality of "custormer service", yet is an unnecessary distraction for clinical staff to have to contend with in the first place.

In light of the fact that the public is well educated with regard to attorney-client privilege (thanks to TV) but is ignorant of medical privacy issues, I think it the responsibility of Health Care Administrators to insulate clinical staff from this distraction.

I love your observations............I thought I had the gift of gab! I bow to you!

I had a unit secretary like that once..........her voice was like nails on a chalkboard!!!!!!!!!!!

She'd squawk.........."CALL ABOUT BED 5 ON 885".............:eek:

I always had "THE TALK" with families. I let them know right up front that the more time I spent on the phone telling people that I cannot release information........was equal time in not caring for their loved one. I would have them designate a "point person" by which the friends and extended family could get their updates. I gave them the best time to call so that I would be able to tell them exactly what was going on....Politely of course;). I let them come up with pass words so I would be able to release information over the phone and this was before HIPAA.

What I really like now these "carepages" that some hospitals use. The family is given their own page to post information and it can be accessed only by password. Talk about a lifesaver! The family now has the means to tell everyone how they are doing. When my Dad was hospitalized the nurses took no phone calls unless the "assigned code" was given (screened, by the way,by the unit secretary) because all necessary information was on the patients website. I kind of ticked off at first,"What do you mean I can't call!" and then really liked it because they I wasn't badgered by family members.....just updated his page!!!!! Of course you need to sign all the "this is not the hospitals responsibility, not medical advice relaease of responsibility" crap. BUt i liked it!

To save a nurses sanity and preserve patient safety and to give nurses more time with the patient I think all hospitals need to go to this way of communication. Not to mention increasing the saftey of unit secretaries!

[Flying ICU RN]

I love your observations............I thought I had the gift of gab! I bow to you!

"Beat em over the head with their own policies," I always say.

Softly and nicely of course!