Ethical decision or Patient's right?

  1. A patient who is A&O x 4, but has a change in condition gets sent out to the ED. They ask you not to call their family because "they already have enough on their hands". Family members are listed as an emergency contact and you know they would want to know if something has happened. (You know both the patient and the family pretty well).

    Respect the patients wishes or call the family?

    I realize this is pretty vague information, perhaps if anyone has any questions I can reply without giving too much information.
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  2. Visit QuietIsntAWord profile page

    About QuietIsntAWord, ADN

    Joined: Jan '17; Posts: 100; Likes: 344
    from NC , US
    Specialty: 5 year(s) of experience in Geriatrics

    21 Comments

  3. by   twinmommy+2
    I would not call. But i would clarify first that he would call their family when he got there and i would tell them if they called the department.
  4. by   ruby_jane
    What is the policy about notifying family of any change in status? I assume that an ER visit is change in status. If the policy directs you to call, you need to do so. If the policy would allow for something like a call when the patient is back with you, just informing the family, then maybe that's what you do?
  5. by   JKL33
    This is easy.

    If the patient is his/her "own person" and has in fact instructed you not to notify or call people, you don't.

    I'm in the ED and this is a frequent situation. Take college kids who are A&O but have an acute situation going on, for example.

    I handle it by discussing it with them. These discussions have taken various forms and angles depending on the situation. Sometimes they actually have a very good reason (one that comes out only with additional discussion). Many times they say, "you're right, let's call them."

    It doesn't matter if you know what the family would want. They are not the patient and they aren't legally charged with making the patient's decisions and your first duty is to your patient.
  6. by   JKL33
    PS - I will say this: Depending on the type of "change in condition" I may be more direct - "That isn't a good idea; you are going to require X, Y, Z and you are going to need support. They will be scrambling to try to help you and it's best they have a head's up....etc., etc., etc."

    One could probably make the case that in a situation where the patient has the competency and capacity to make current and ongoing decisions, the "emergency contact" policy (if there is one) doesn't come into play because the actual situation for which it is intended doesn't exist.
  7. by   not.done.yet
    If the patient is A&O x4, there is no question here on what is to be done. Notifying family against their wishes is to flirt with a HIPAA violation. Emergency contacts are in case a patient is unable to speak for themselves.
  8. by   QuietIsntAWord
    I agree with not calling, but I can't help but think if they had gone downhill even further once they left my care, I'm sure they would have wanted the family there. I understand some patients not wanting family to know because of private matters but this one in particular just didn't want to burden the family and I don't think they understood how critical their condition was.
  9. by   Emergent
    Quote from QuietIsntAWord
    I agree with not calling, but I can't help but think if they had gone downhill even further once they left my care, I'm sure they would have wanted the family there. I understand some patients not wanting family to know because of private matters but this one in particular just didn't want to burden the family and I don't think they understood how critical their condition was.
    If things go downhill then the receiving facility will have the emergency contact's number, and can call. Let them know the patient's wishes and do CYA charting.
  10. by   not.done.yet
    Yes, if the patient goes downhill, then it will be the other facility's responsibility to reach the emergency contacts. The patient may say they don't want to burden family, or they may dread the burden family makes them feel like. Whether or not we agree with their reason is beyond our scope of practice. The patient's autonomy, when in their right mind, is our primary goal. While your concerns are understandable, they are not actionable in any ethical scenario and you did well to respect the patient's wishes.
    Last edit by not.done.yet on Mar 7
  11. by   QuietIsntAWord
    Thank you all for the responses. It has been bugging me all day. Not a fun situation to be put in for sure.

    Recent update that family was eventually called, so that makes me feel better too.
  12. by   bugya90
    Some ALF and Nursing Homes have all residents sign paperwork stating that their designated point of contact will be notified in the event that they are sent to the hospital. (I'm not sure from your post if you are sending the patient out from the nursing home or receiving the patient at the ED).
  13. by   QuietIsntAWord
    I was sending the patient out, but could find no form that showed either family member had HCPOA
  14. by   QuietIsntAWord
    Quote from bugya90
    Some ALF and Nursing Homes have all residents sign paperwork stating that their designated point of contact will be notified in the event that they are sent to the hospital. (I'm not sure from your post if you are sending the patient out from the nursing home or receiving the patient at the ED).
    I think this is a gray area for us... we do have emergency contacts, but I don't think we have any kind of guideline on when or when not to call. Maybe this is a learning experience, I'll def. talk to my supervisor first chance I get. Perhaps it's something I wasn't aware of.

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