Urine Drugscreens without pt's permission?

  1. These are always ordered on suspicious pts, and I'm curious if that is the case everywhere? Isn't there a privacy issue here. Certain things we need to get permission for, such as an HIV test, which I don't understand. What other tests do we need permission for?

    Just to add something, when I get a urine drug screen, I always just ask for a urine sample, it's always hush hush, I've never announced to the pt that I need the sample for a drug screen.
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  2. 15 Comments

  3. by   Katnip
    In the ER we have drawn blood for drug and ETOH screens if there are signs they are using. It's important to know what they're using. Don't always mention what it's for, but then I don't tell people details of why we're drawing any blood, even if it's just CBC/BMP unless someone asks or if there's lots of time to explain. I just say tell them we need to run blood tests.
  4. by   TiffyRN
    I know there are probably other tests that require consent but the only one I know of off-hand is HIV. I'm pretty sure that's because back in the day there was a HORRIBLE stigma and certain death sentence.

    Otherwise I don't get into tremendous detail with what I'm getting blood/urine for. I pretty much leave it at "measure the electrolytes, chemicals, bleeding times, blood count" unless the patient presses for details; I won't lie to them if they ask specifically if I am getting a drug screen, but I've never had anyone ask that so far.
  5. by   Spidey's mom
    In the ER, if they are coherent, they sign in and agree to tests and such.

    Otherwise, we don't ask them if it is ok to do an EKG or test them for electrolytes or cardiac enzymes, etc. Why ask for drugscreens or ETOH?

    steph
  6. by   Nursonegreat
    very excellent point of view and i agree stevie and others. does anyone do dipsticks for drugs? we have started doing them for cocaine in preop in an ASC that has to send all labs out usually (and this takes hrs). any input?
  7. by   MomNRN
    Sorry to say I don't always inform of my intent. Our hospital has a blanket consent form which covers it all. If they explicitly ask, I explicitly tell. Otherwise I just tell them the doc ordered lab work which includes a urine sample.

    Surprisingly very few people question what we are doing with them.
  8. by   babynurselsa
    Pt sign a consent for tx.
    The only additional things that we have consent for usually are invasive prcedures.
    A drug screen may be important information in dx or implementation. What if pt was brought in for altered LOC, an ETOH of 300 goes a long way towards explaining this. If a mother tests + for benzos and you narcan the baby...could be bad news.
    If I am directly asked I will tell, but I routinely do not inform pts of each and every ordered lab test.
  9. by   SCRN1
    We also have a blanket consent that the patient signs as soon as they come to the hospital that gives permission to test for whatever's needed.
  10. by   CritterLover
    we don't get consent, either, and i rarely mention why i need urine.
    [color=#483d8b]
    [color=#483d8b]i have noticed, however, that some patients automatically assume that any requested urine is for a tox screen. i had one kid (in his 20's) tell me last week "i can't give you any urine. i'm dirty!!!" he was also quite drunk . i just looked at him and said, "it's ok. who do you think we're going to tell??"
    [color=#483d8b]
    [color=#483d8b]i think it is important to realize that the drug screens we usually do in the er (at least where i work) arn't valid for forensic purposes. mostly because we treat it like a routine ua: have the patient pee in a cup, label it, and tube it to the lab. no quality control, no chain of custody papers, nothing. there is even a little disclaimer on the results that state they are only good for medical purposes. if we have an workman's comp patient where the employeer has requested a drug screen, then someone from the lab has to come over and run the test, with all the appropriate forms signed and hoops jumped through.
    [color=#483d8b]
    [color=#483d8b]by the way, not all states require consent for an hiv test. the one i currently work in does not. if you get stuck with a dirty needle, a needle stick panel is ordered on the patient. no need to wait for a doc to come up and "counsel" a patient about getting the test, and then gettin their permission. not the case in the last state i worked in, where a needle stick panel couldn't be run until the patient consented.
  11. by   Patti 2nd gen RN
    Anybody out there know a list of which states require consent for HIV/needlestick panel testing and which don't??? I worked in a place where a patient refused conset tothat testing after a pregnant nurse got a dirty stick, and it made the rest of her pregnancy very stressful, and less joyful---somewhere in there I feel like her right to know was stepped on.....and what about when you have been raped, --what about testing and consent then????
  12. by   GardenDove
    Quote from Patti 2nd gen RN
    Anybody out there know a list of which states require consent for HIV/needlestick panel testing and which don't??? I worked in a place where a patient refused conset tothat testing after a pregnant nurse got a dirty stick, and it made the rest of her pregnancy very stressful, and less joyful---somewhere in there I feel like her right to know was stepped on.....and what about when you have been raped, --what about testing and consent then????

    I agree, that's totally ridiculous. Where I live in Washington the pt has to give consent. I know because of my own needlestick. He did give consent. The pt was Hep C pos, I knew that already. Tatooed from head to toe, extensive drug and criminal hx, and owned a tattoo parlor. He was also a high need, self absorbed, drug seeking jerk!:angryfire

    In my opinion everyone should be screened at least if there is a needlestick automatically. Why is the law so slanted in favor of the pt and not protecting the healthcare worker? Everything is confidential in the hospital. They wouldn't do that if they had MRSA. It really is unreasonable and I'd like to see JCAHO start protecting healthcare workers for a change. :angryfire Where are our lobbiests in Washington, at some cocktail party hobnobbing with paperpushing nitwits who don't know which way is up?
  13. by   TiffyRN
    Urine and meconium (for newborns) drug screens are not collected with the whole chain of custody thing in our L&D and NICU. The results though are good enough for CPS and as far as I know they go to court with them.

    We've had extreme cases where on the basis of positive drug screens (and previous CPS cases) parents are denied visitation rights with their infant who is in the NICU.
  14. by   babynurselsa
    Our UDS screens did not have chain of custody but our mec screens did.

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