Autonomy

Anna Flaxis, BSN, RN · Jan 5, 2014

I don't really have this problem, because if the teen is there for a twisted ankle and just needs an xray, or a sore throat and just needs a rapid strep, I really don't have any reason to ask the parents to step out. If the teen is there for pelvic pain and needs a pelvic exam, parents are typically more than willing to step out during the pelvic, and the doctor can ask those sensitive questions at that time.

bebbercorn · Jan 6, 2014

Blame HIPAA and invite them to write their Congressman.

sdegracia · Jan 6, 2014

I think that it's safe to ask the patient if they would like to have the other person present during the time of the interview. Working in the ER we've come across minors and even adults who bring in their parents or other visitors, and we ask first if they want them present if we are talking about the medical things pertaining to their cases.

Even if it's for a sprain, a fracture or such, we have to ask female patients if they are sexually active, when their last MP was, so on and so forth because of the diagnostic tests they will perform, you don't want to expose a little life to radiation if they are pregnant. And also with regards to pain medication and dosing, the doctors need to know what they're going to order.

Hope that helps somehow. =]

Anna Flaxis, BSN, RN · Jan 7, 2014

Even if it's for a sprain, a fracture or such, we have to ask female patients if they are sexually active, when their last MP was, so on and so forth because of the diagnostic tests they will perform, you don't want to expose a little life to radiation if they are pregnant. And also with regards to pain medication and dosing, the doctors need to know what they're going to order.
Hope that helps somehow. =]

X rays of the extremities are considered safe during pregnancy, both due to the fact that the radiation is not being directed at the fetus, and even if it were, the dose of radiation in a plain x ray is low enough to pose little, if any risk. For a person who is concerned, shielding of the abdomen/pelvis can be used.

As far as prescribing, Dilaudid, Percocet, and Vicodin are all pregnancy category C medications, which are prescribed to pregnant women all the time because the benefits outweigh the risks. We do not require verification of pregnancy status of every single woman of childbearing age who comes through our ED and needs pain control.

LMP is not reliable information. Neither is whether the person answers yes or no to being sexually active. If you really need to know pregnancy status, the person needs a urine or serum pregnancy test performed.

The major indications for pregnancy test in the ED are if the person is to undergo a CT scan or if they are having low abdominal/pelvic pain and/or lady partsl spotting or bleeding.

So again, if the person is simply in with a sore throat or a twisted ankle, it is not necessary to know their LMP, whether they are sexually active, or whether they could be pregnant.

Clearly, policies will vary from ED to ED.

freki, ADN, RN · Jan 12, 2014

So again, if the person is simply in with a sore throat or a twisted ankle, it is not necessary to know their LMP, whether they are sexually active, or whether they could be pregnant.
Clearly, policies will vary from ED to ED.

In our ED, the policy is to ask about sexual activity, LMP, and domestic/relationship abuse if the female is over 12-years-old or has obvious secondary sex characteristics. I believe this is a requirement of "meaningful use" for CMS, but if you think about it this is much more than just "is it medically necessary". The ED ends up being a filter for many high-risk populations and often the chief complaint isn't the biggest problem for that patient. I've witnessed this several times with women who would repeatedly come back to the ED for "abdominal pain", but divulge that they are being abused, are fearful of their lives, or just don't know how to get help for whatever is going on in their lives. Yes, this happens in teenagers as well. Whether we like to admit it or not, sometimes mommy and daddy (or more often, step-dad/mom) are abusers.

So I would say, don't be afraid to ask about this kind of stuff. Emergencies aren't always the broken bones and heart attacks.