Advice please

crazin01 · Feb 23, 2017

I am honestly curious...

Would this really be a violation? If patient wanted privacy from family while you're administering medications, patient could have asked for 10 minutes privacy.

If I'm visiting family/friends in hospital, I always ask if they'd prefer I leave for privacy (med admin, wound dressing, foley insertion, etc). I've seen many visitors offer this courtesy to the patient. I know many others feel the same in that: If visitors remain in the room and do not step out, the patient feels that it's acceptable for them to remain present.

I think it was wise of the family member to inform you about others' knowledge regarding patient. And sounds like she was nice about it.

I'm sorry I haven't helped much....

Moving forward:

I've flat out asked patients, with stigmatized diseases, what they are ok with being shared and to whom.

I have seen many charts, with obvious 'look at me!!' signs on the front, stating: only Mary (patient's daughter) is allowed to be informed of XYZ.

I'd say to not beat yourself up too much, but know I'd feel the same way, in your shoes. It's definitely a good learning experience.

Abhnurse9 · Feb 23, 2017

I appreciate your response. I feel much better after hearing another's point of view. It has most definitely been a learning experience, and I will use your advice in future situations, like asking the patient flat out if it's okay to talk in front of family, etc, especially in delicate cases like his. I am normally very cautious about what I say in front of others, including family members; I'm not sure what got into me. Clearly, I need to be more cautious. It was a honest mistake, but either way, I can't undo it, and I will always feel horrible. And you're right, I am very thankful that the family member was nice about it! Thanks again for replying.

kp2016 · Feb 23, 2017

Given that no actual harm was done here I would suggest that you treat this as a learning experience and move on. Do not self report yourself to anyone else. Putting a blemish on your record that can be used against you at a later date will help no one, least of all you.

brownbook · Feb 23, 2017

I can't see any difference in what you did and your telling a patient how much insulin you were giving them or that you were giving them their morphine, or antibiotic, etc. I know, HIPAA can be vague and confusing, but if the patient asks, permits, allows, family to be at the bedside it seems implied consent that the family is going to hear a lot about why the patient is there.

Hospitals are pushing to allow families to stay with their loved one 24/7. (Which by the way I think is great.) But the issue of HIPAA disclosure must be made clear to the patient and staff.

Abhnurse9 · Feb 24, 2017

Thank you for your reply. I agree with you 100%. I think it's awesome that family members are at the bedside with their loved ones 24/7, but it does make it a little harder at times to make sure patient privacy is maintained. I think the only difference with this situation is that the disease is a sensitive subject and that's why I feel horrible about it. If the family member was unaware the patient had diabetes, I wouldn't even think twice about accidentally saying so. Again, thank you for your reply. I am starting to feel better about the situation. I have definitely learned from it, -'d will make sure I am on my A-game from now on.

brownbook · Feb 24, 2017

I understand what you mean, but we need to not look at AIDS

brownbook · Feb 24, 2017

Great, but I wish someone smarter than me would respond, what are the HIPAA rules when family is at the bedside?

Every time a nurse enters the room do they have to ask the patient, "May I talk about your care, drugs, treatment plan, with your family present." before they say anything? That would get a bit tedious.

RobbiRN, RN · Feb 26, 2017

I just googled the HIPPA statues for a quick refresher. Yes, they are vague. But they do imply that sharing of information is necessary during treatment. If a patient wants his/her information to be kept secret from visitors present during treatment, it is the patients responsibility to speak up. It's implied consent if the visitors are present. HIPPA also allows the sharing of information with significant others if the patient is not able to communicate. You did nothing wrong. (Why hasn't that risk management guy weighed in on this one?)

JustBeachyNurse, LPN · Feb 26, 2017

That would be an acceptable incidental exposure. Now if the family member asked you directly and you answered different story.

ilhamtony, MSN · Feb 19, 2020

If your facility is part of an incident reporting program; you enter an event/or incident that identifies the circumstance genuinely. You get this burden off of your chest, and move forward. The reason you enter this information is to provide awareness to the Risk Manager about how this occurred, very detailed, fact driven and enter the comments made by the family member for about the exact date and time of day-If the family member changed their minds, you have it documented that this occurred and the family member did in fact, change their mind. Yes, you did violate privacy requirements (by accident) and it feels horrible and is concerning at the time, once you have documented the breech properly, you have no concern. Incident and Event reporting is to identify if this occurs frequently, what the RM/Compliance/Quality Team can focus on to remind staff the importance about discussing personal information about patients with family and friends present. Doctors have done this routinely and it is privacy violation any way you cut it.

You will be okay if the facility you are employed at uses the incident reporting mechanism the way it is intended, non - punitive and re enforcing good practice.