answering the patient's daughter's call = invasion of privacy?

[neurontin]

If a caller identifies herself as the patient's daughter, and asks, "How is my mom?"

What am I supposed to do?

[OttawaRPN]

Is the daughter the POA??

[neurontin]

No, she is not the patient's power of attorney.

[BluegrassRN]

If the mother is able to speak, I usually just say something benign like "Why don't I just transfer you in, so you can speak with her directly?" If the family member insists on speaking directly to the nurse, I either ask the patient if it's okay that I speak with them, or I ascertain who has been indicated as DPOA. Sometimes, too, in the H&P our physicians list whom the patient has designated as a surrogate decision maker, and with whom we can discuss their condition.

If I have nothing to go by, no alert patient, I play it by ear. Sometimes I simply apologize and say I am unable to give any information over the phone to anyone other than the DMPOA, due to privacy rules. If it's a family member whom I have seen and interacted with on the floor, with whom I'm familiar, I will provide certain information. For example, a daughter who is there all day with her mom, leaves at 10pm, and calls at 2am wondering how she's doing. I'll tell her how she's slept, that sort of thing. I'm not going to give any lab results or anything like that over the phone, but that's typically not what they want to know. Typically they want to know if they appear comfortable, when the doc will be around, when they will be discharged (for transportation purposes), that sort of thing.

Most people are understanding.

[RN9742]

At my son's hospital they have set up a plan in place for this. Since it can become a tricky situation, basically they assign you a code when you are admitted, the patient or the guardian lists who it is ok to speak with on the form. So I could give the code to my son's father, and he can call in and check on him if need be. Or obviously if I could not be there I could check on him as well with the same procedure.

Otherwise, you are left needing to pass the phone to mom, or just give the very basic stable, serious etc answer.

[OttawaRPN]

If the patient is not A&O and the caller is not the POA, I provide no information other than "I'm sorry but you have to speak to regarding her condition." Unless you know the family, you never really know who you are talking to.

I have dealt with families with some very strange dynamics. A son who we are to call police on if he tried to contact his mother, a daughter who is verbally abusive and even a husband who tried to "steal" his wife from the hospital so in the very rare case I give information to another, it's only because the patient is able to give consent.

In person, it gets trickier because the patient may have many visitors; in the case of palliation strangers may ask "how is she doing?" and a simple "she's comfortable" is usually enough to appease the curious.

[neurontin]

Can I suggest the daughter to contact the primary care provider?

[nurse2033, MSN, RN]

We use a code system. When the family is present we give them a code taken from the last four digits of the patient's hospital number, which is on all their charting and labels (assuming that's OK with the patient). If that doesn't work I look up next of kin in the computer and call them back using the phone number in the chart. If I have met the family member and their caller ID shows their name I'm comfortable with talking with them. I also will transfer the call to the patient, (if they are able to talk). I recently had to call the police because a patient's family member called and when I asked for the privacy code he said "if anyone asks me for that stupid code again I'm coming down there with a shotgun", yup true story. Just explain why we can't discuss over the phone without identifying the caller. You don't know family dynamics and who is legitimate or not.

[casi, ASN, RN]

Our face sheets have family contact information that the patient has okayed us to talk to.

[systoly]

You do come across some interesting family dynamics and sometimes it's not ok to even acknowledge to a family member that the patient is indeed at the facility. Therefore, if I don't have express permission from the patient, documentation or POA, I say, " At this time it is against the law for me to disclose any information."

I don't make apologize or make excuses for HIPAA.

[msjellybean]

Our face sheets have family contact information that the patient has okayed us to talk to.

This is what my hospital does as well.

[nursel56]

Having just been through this as "the daughter" myself I have some very strong feelings about it that I thought about starting a thread about, called "a little bit of knowledge is a dangerous thing".

Sometimes a patient's condition has a sudden enough onset there isn't time to make up a complete contact list. Anyway when I called to talk to my mom's nurse she went through the whole HIPAA thing - and I guess trying to be helpful offered that my mom was very tired and sleepy. When I asked what the reason for that might be she sort of hemmed and hawed - and after a while would only agree that it was probably just from the stress and pain she had been through that day.

It turned out what really happened was that my mom had developed uncontrolled bleeding of unknown etiology at that time and had required admission to the ICU and transfused several units of blood, and that she had a period of disorientation for several hours as well.

But the "little bit" of info supposedly meant to reassure me gave me a false picture of the real situation, which thank God did not deteriorate further. I don't really blame the nurse but cruel as it may seem not to offer any info it may be better than offering it in dribs and drabs and creating a more benign picture than was the case.

Having thought about this for some time I think the best thing would be to use a PIN number to identify those who you want to allow access to your information in the hospital. It's not foolproof - or a perfect solution but I don't know one that is and protects the patient without putting the staff on the spot with answering questions in a general way in an attempt to reassure but unwittingly creating a false reality.