Confidentiality and phone calls

[ScreamBoxDolly]

Alright so yesterday I had someone call up at the nurses desk to talk to someone. He seemed very distressed and needed to talk to lets say bed 245-1. I tried to transfer him to the bedroom, (not giving out any names or anything), and I must have not transferred him right because 10 minutes later the phone kept ringing. I then asked someone to help me out, and they said "I dont think we can transfer them to the room, but we can give them the room number". I was about to tell this person the number, but.....the man went on a rant, gave me his number to give to the patient, and was drunk, and was yelling at me. After he hung up on me, I went down to the patient and asked if they knew him...they did and said "oh thats normal, I will call him later". Well when I went into the patient's room an hour later, I found the patient crying on the phone with this man. I asked the patient if they didn't want to speak to him again, and they replied "yes". So I told everyone on my floor who this person, that they were drunk and that if he wanted to speak to the patient, he couldn't (pt request) and the last person he could talk to was me, since I was the pt RN and pt advocate.

Since I am new to nursing, after looking back, I should have first asked this guys name, got his number then went to the pt first to see if they knew him. My reason for writing is:

1. What should I do in the future to protect pt confidentiality...for example you know how when you get busy, family calls wants to find out how their mom or dad is and you say "oh they are fine"....(what if that person shouldn't be calling, and I just think they are family)----how can I stop myself before I blurt out something?

2. If I ever find myself in that predicament with a drunk belligerent family member or spouse over the phone, how could I go about a better way protecting the client and keeping them from calling?

Thanks guys for your help and advice.

[noctanol]

i am an LVN and encounter this all the time, due to the fact that i work in a nursing home. 1st and foremost, dont give "sensitive" info over the phone such as room numbers, rather tell the person that when they get to the building they can ask for the charge nurse and will be directed to the person they are looking for. Also, in the facility i work for, if a person is not included in the residents face sheet, then they cannot get any info, regardless of relationship to resident, saying someone is doing "fine" is a very general and vague term, and coming from a nurse, family members usually associate the term with the person being in no risk which may not be the case.

it takes practice and patience, just be mindful when you say anything. and be prepared for "she/he is so rude, he doesnt give any information" hope this helps

[Davey Do]

ScreamBoxBolly:

I can appreciate your situation- wanting to fulfill requests, yet not cause any negativity to result. We have to tow the line in our profession.

First, be objective. The caller was not "drunk". He may have been intoxicated, but a BAL is necessary to confirm this. Objectively speaking, the caller may have been slurring his words and speaking loudly. If you were speaking to him face-to-face, you may even note that he smelled of alcohol. Direct quotes often convey a good sense of the situation.

Next, some sort of release of information procedure needs to be in place. Often times, release forms are utilized to specify who may recieve information about a particular patient. A code word is given only to those callers, designated by the patient, who can be given information. Otherwise, a name is taken, verbal consent is obtained, and the patient's presence is acknowledged. Document the verbal consent.

Often times, we have to say that we can neither confirm or deny that a certain individual is currently a patient in our facility, unless we have a release of information. It doesn't go over well, but rules are rules.

A lot of times, verbal deescalation skills are necessary to deal with the result.

I hope this helps you, ScreamBoxDolly.

Dave

[pharmgirl]

When I worked on the floor in order to give out any information the caller needed to have the patients "pin" number, which was the last 4 numbers of their medical record. They could only get this information directly from the patient.

Now that I'm in the ER, I get A LOT of frantic phone calls. Since I'm a new nurse and new to the ER, I've asked a lot of questions regarding this and it seems every nurse has their own way of handling this. Some will go track down family, some will just say "they are stable at this time". I've decided that unless the family is within sight I say "Due to privacy laws, I am unable to release any information over the phone, you may contact the family or I can transfer you to the waiting room lobby and you can ask if there is family here". If there is family floating around, or if I have time, I will go ask the patient if I can release information and then I will chart it.

Im just not taking any chances. It may be a little too conservative but I dont care, I'm not getting accused of HIPAA violation.

[cebuana_nurse]

It is a sensitive issue. In my facility, we always ask the person that is calling and check their face sheets if these people are allowed to get any info with regards to the resident's condition. If they are not on the list, we politely say, "I'm sorry I cannot divulge any information to you over the phone due to confidentiality issues."

This also applies to visiting families and friends.

[bagladyrn, RN]

It's somewhat impractical to try to "screen" calls and put only certain calls through. If a patient wants to restrict calls I will tell them that I won't transfer any calls to the room and that they can give the direct number only to those with whom they wish to talk. If I am aware the patient is sleeping (postpartum) or working hard in active labor I will let the caller know that I can't put the call through at this time and will be glad to take their number and give it to the patient or family.

As for specific information, I don't give any out, citing patient privacy laws, but suggest they contact patient or family member for specifics.

Of course I get a certain number of indignant replies, but seldom any complaint from the actual patient.

Not being a totally heartless person, if I get a caller for instance saying "I'm calling from overseas to see if my first grandchild has arrived yet" I'll put them on hold and trot down to the room to see if anyone wishes to take the call.

[Ruby Vee, BSN]

1. what should i do in the future to protect pt confidentiality...for example you know how when you get busy, family calls wants to find out how their mom or dad is and you say "oh they are fine"....(what if that person shouldn't be calling, and i just think they are family)----how can i stop myself before i blurt out something?

2. if i ever find myself in that predicament with a drunk belligerent family member or spouse over the phone, how could i go about a better way protecting the client and keeping them from calling?

thanks guys for your help and advice.

we try to have just one spokesperson for each patient. that solves a lot of the problems you describe unless, of course, it's the spokesperson who is being verbally abusive. if someone is being abusive over the phone, it's perfectly legitimate to tell them that you don't tolerate being spoken to in that fashion, and that they should call back when they have more control. (or something tactful that conveys the same message.) i work in icu, though, and we don't have phones in our patient rooms. i'm sure that changes the situation.

when someone calls for information, i usually ask the person calling "are you a friend of mr. colectomy?" don't ask if they're family, because it's too easy to just say yes. ask if they're a friend. if they say they are, then you know they're not immediate family and can refer them to the family spokesperson. if they answer with, "no, i'm his second twice removed cousin bob. or is it third cousin once removed?" i know they're not immediate family and can refer them to the family spokesperson. if they say "yes" and leave it at that, i'll sometimes ask the relationship, especially if i know the patient has family issues. if they say they're the patient's sister, son, spouse or significant other, then you'll know how to respond.

asking the person's phone number and telling them you'll have the patient call them back "when he's done with his dressing change" or tests, or whatever, is legitimate. then give the patient the number and let him decide whether he wants to talk to aunt lizzie who has slurred speech, abusive language and barroom sounds in the background.

[diane227, LPN, RN]

You don't state what type of unit you work on. If you work on a psych unit, the rule are different.

In my practice on med surg when I get a call I transfer it into the room unless the patient is a no information patient. If the patient has said that they do not wish to talk to a certain person I usually take the name and number and tell them that I will deliver the message. Or sometimes I just tell them the patient is sleeping if I know the patient does not want to talk.

When a family member calls for information, I transfer that call to the primary nurse unless it is a question that I can answer. I don't give out much information on the phone under normal circumstances. I might say the patient is doing well and would you like to talk directly to him/ her? There are times that I give detailed information on the phone when I know the caller and the patient cannot speak for themselves or the patient requests that I provide the information. For example, I may know the patient and the family well. If they call for an update, I will provide this to them.

Giving medical advice on the phone is another matter. If a patient calls back to ask a question after discharge I will find their chart and try to answer their questions. If they call a week later and I know them, remember them, I might try to answer the questions but sometimes I have to refer them to the ED or to the doctor that did their surgery for example. When in doubt tell them that you cannot provide this information over the phone. If they insist, refer to the charge nurse or supervisor.