Patient is a sex offender with a tracker on his ankle - page 3
When I received shift report for my very ill, bed-bound patient, the RN giving report pointed out the tracker affixed to his anklet. She had admitted him a few hours earlier and did not know the... Read More
Jul 24, '17This information is important in a shift report and for management. Even though the patient is bed bound you still have to be aware of other patients with underage visitors (especially if its not a private room). I wouldn't add this to his personal medical record as it is not relevant to his care. As nurses we have this expectation to be perfect when in fact we are human too so it's only natural that other nurses will be curious. If a patient was rude would you include that in report?
If you present the information during report and emphasize that the goal is to provide appropriate and fair care I think it will create a better environment. At the end of the day most of us have probably taken care of countless criminals without even knowing it because they weren't "branded". It's the same thing as using standard precautions: treat everyone the same.Last edit by sirI on Jul 25, '17
Jul 24, '17Lets put aside whether or not it was wrong for the nosy nurse to have googled the patient.
Why on earth would the results of her google detective work have any place in the legal record of the patient's care?
Jul 25, '17We look all of our patients up on Sex Offender Registry. We need to know for placement. Sex Offender registry is public information.
As far as the ankle monitor, it's good to know in advance so when the police call to verify person is there.
Jul 25, '17Quote from TashaCaraballo...not getting the relationship between HIPAA and Google. Yes, this action may have consequences for the nurses involved and what they DID with the info learned, but anyone can Google anyone.As horrible as the information you have found out, no one should've google him (HIPPA). People get fired for things like that. Just do your best to treat him, the law will handle the rest.
Jul 25, '17Can he talk? I think it would have been appropriate to ask the patient "Do I need to know anything about your ankle bracelet?" and documenting anything he tells you. I would also assess for edema in the area.
Documenting pedophilia in the chart is not appropriate. But a sex offender search is legal for anyone to do. I don't think it's necessarily helpful, but it's legal.
Sex offenders are everywhere. You see them all the time and never know it. Why worry about the one who is bed bound?
Jul 25, '17"When I received shift report for my very ill, bed-bound patient, the RN giving report pointed out the tracker affixed to his anklet. She had admitted him a few hours earlier and did not know the details and there was nothing noted in his chart. Before she left, she looked online and he is a convicted sex offender (lewd and lascivious with a minor under the age of 14). Is it appropriate to add this new information (pedophilia) to your shift report? To his chart?"
The short answer is that subjective and objective information needs to be assessed and documented related to Sexual Aggressive Behaviors. It absolutely should not be ignored and not left out of the patient's chart for a variety of factors. The patient first should be assessed and asked a variety of questions including: Why is he wearing the ankle bracelet? What is his legal status? If he admits to being a sex offender, then what is his level (I, II, III). Do they have a current parole officer? Does the patient have a legal court order limiting their contact with minors or individuals? When was the patient's last offense? Do they have support group? How are they managing their behaviors?
If the nurse cannot acquire this information, it should be communicated to social work for follow-up. Barrier's for discharge are significant. SNF, AFH, and Psychiatric facilities have specific assessment requirements for admissions criteria. Level three sex offenders are usually not accepted for admission due to the severity of criminal activities and number of repeated attempts. Please do not assume that just because an individual has been listed as a level one or two sex offender, that they have only committed minor offenses. The criminal acts may be significant but fact checking is required. Using public police records, or court sites to verify information is not breaking HIPPA. Every state has guidelines on keeping track of sex offenders, including police following specific rules on reporting to the public whether or not a sex offender is entering a community.
This information should be in the patients chart, and not just in verbal form. How are you maintaining UNIT safety if this information is just by word of mouth. If you have minors on your unit, how would nursing staff consistently know if a patient was not supposed to be in direct contact with such minors? Is nursing staff aware to educate visitors to monitor their minors at all times? If the patient is being truthful and acknowledges that they are not to have contact with minors, how is their nursing care plan addressing that issue? Not making it part of the care plan can easily allow errors to occur, that can harm the patient, not just staff or visitors. In addition, the ankle bracelet is a legal tracking device. If the patient elopes (in the case of having a restriction from discharge order), law enforcement would want to know if we were documenting whether or not the ankle bracelet was still in place.
Being a sex offender is a mental health issue so to just ignore that medical concern makes no sense and leaving it by word of mouth during shift reports allows assumptions, and incorrect information to be formed and passed on.
Jul 25, '17I agree! We had a nurse admit a patient with one and they didn't plug it in, Sheriff's Deputies showed up looking for him. It can also get them in a lot of trouble.
Jul 25, '17Quote from Alex_RNGood Lord, why would you think it was appropriate to put the results of an unsanctioned Google search on a patient's chart? The ankle tracker is important to pass on from shift to shift -- it may have implications if an MRI is ordered, for example. Security should also be aware. But looking on-line for the offense just amounts to malicious gossip.When I received shift report for my very ill, bed-bound patient, the RN giving report pointed out the tracker affixed to his anklet. She had admitted him a few hours earlier and did not know the details and there was nothing noted in his chart. Before she left, she looked online and he is a convicted sex offender (lewd and lascivious with a minor under the age of 14).
Is it appropriate to add this new information (pedophilia) to your shift report? To his chart?
Jul 25, '17That the nurse looked this info up is SO out-of-line, I don't even have the words to rant about it. As many others have pointed out- does this information improve your care? And, just so you understand how the system works- if a man is nude sunbathing in his own fenced backyard, and a kid looks over the fence and sees him, he actually can be charged and registered as a sex offender with a victim under 14. If he is peeing on the side of the road, same thing. It doesn't necessarily mean he ever laid hands on a child, or was involved with someone else doing so. It's all up to the judge and prosecutor. We have to guard against being too quick to judge- regardless of someone else's mistakes or actions. I'm not saying there aren't evil people in this world, but we signed on to care for every patient, there were no disclaimers or exception clauses- right?
Jul 25, '17Safety and security of all patients, staff, and visitors is a primary concern. While the patient is entitled to the same care as another, it does warrant a properly individualized risk assessment and notification of the appropriate authorities in house or otherwise.
An investigation should never be undertaken by someone involved in a 'direct' care capacity. If the patients' health or care becomes 'compromised' it could result in an investigation of medical/criminal neglect. Avoiding investigations and civil rights lawsuits are a good thing.
That being said, I worked for a Pain Management Practice where a substantial number of our patients were convicted criminals. After a violent altercation with Doc and an assistant, I began screening the patients for violent offenses via government databases. As a private practice, we had the ability to deny care which doesn't fit into your scenario.
If the information is readily available via internet from a trusted source of public records, courts, or law enforcement agencies there is no right to privacy due or expected. This information is published for reasons which includes informing the public at large.
Jul 25, '17First...it is HIPAA not HIPPA...lol
This is one of those issues best brought to your manager and risk management/lawyers. When there is criminal activity/investigation HIPAA allows disclosure....but this person had served their time. The courts felt he was at risk for re-offending...hence, the ankle monitor. Googling your patient is probably not the best behavior. However, sex offenders history is available to the general public so "privacy" isn't exactly in play here.
What makes this important? If this patient was admitted to an adult floor that also has peds patients. A roommate that has young girls visiting. Most sex offenders have rules to follow about the presence of children to them. It can become a huge mess. In general I would suggest you go to your manager and ask her for the policy for patients with ankle devices, the care of these devices, and the removal for tests.
Jul 25, '17I have taken care of many patients with ankle monitors and pt's that are currently inmates. I do not google what they are in for and I do not want to know. I would prefer not to know and would not pass the information along in shift report.