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Hep C positive result

Nurses   (2,197 Views 15 Comments)
by Almabella Almabella (Member) Member

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Hey everyone!

I'm a new nurse at a community clinic (an area of nursing I've been for a while), and this week i had my last day of orientation. The nurse training me in left an order for me as part of my "orientation" - to call a pt with a + hep c result.

In my heart of hearts I felt this was wrong. Apparently the pt has a hx of "suspected" IVDA (long term narcs use) and multiple tatoos, blah blah blah. Regardless, the pt is still a human being, and I feel no one should get this result over the phone! I clarified with the doc that she actually wanted me to call the pt with this and received a resounding yes.

What I don't get is, we can't give +HIV results over the phone, but we can give a + Hep C? Does this seem right to ya'll?

I think in the future I might just have the pt schedule an appt to RTC to review labs and too bad if the MD doesn't like it. I was kind of in a tough situation this week as I'm brand spankin new and don't want to start off stepping on toes... Just looking for feedback here.

Thanks!

Alma

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FireStarterRN has 15 years experience as a BSN, RN and specializes in LTC, Med/Surg, Peds, ICU, Tele.

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We call people to tell them lots of bad news, including that their loved one died. What about positive biopsy results or any other bad news? Why is HIV given special status? I wouldn't have a problem with it, but I don't work in a clinic.

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We call people to tell them lots of bad news, including that their loved one died. What about positive biopsy results or any other bad news? Why is HIV given special status? I wouldn't have a problem with it, but I don't work in a clinic.

Well, are you the nurse giving positive biopsy results? My guess is the MD comes and speaks with the pt regarding these matters, first of all. Second, by law, we cannot give a + HIV result over the phone. The pt must come to the clinic for that result--and if they do, they are scheduled with the MD, not the nurse.

I personally wouldn't not want to get any devastating info, be it a CA diagnosis, +HIV or +Hep C result over the phone. That's me.

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RNfromMN has 4 years experience as a BSN, RN and specializes in Developmental Disabilities, LTC.

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I personally wouldn't not want to get any devastating info, be it a CA diagnosis, +HIV or +Hep C result over the phone. That's me.

I thought about it & I think I'm with ya on this one.

There are serious lifestyle changes that are part of the recommended tx of this disease that this pt needs to be aware of. Are you supposed to be responsible for giving the pt all that information? (Not saying you're not competent, just don't think that should be your responsibility - especially as a new nurse).

And if the MD is going to have a follow up visit to discuss the prognosis & such, why not just give the news then?

I don't know...this just doesn't seem right to me.

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jmgrn65 has 16 years experience as a RN and specializes in cardiac/critical care/ informatics.

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Ok in the hospital we arent' supposed to give the patient results unless the doc has spoken to them, it is diagnosing.

I think the doc needs to be talking to them, they will have questions that as nurses we can't answer. I don't think I would be working for this doc for very long. just my 2 cents.

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HIV is often handled in a special way because of the history and hysteria that used to surround it and the fact that the gay community was very active and vocal (not saying tthat's a bad thing). Now that HV is not the death sentence it was, we will probably see some of this fall by the wayside. (It already is, with the new recommendations that people "opt out" of testing, as opposed to "opt in.)

What about the consideration that people infected with HIV and/or Hep C need to be told ASAP so they can use precautions to not infect someone else? Or that fact that this population can sometimes be non-compliant (may make an appointment and not keep it, or move and be unreachable). They should be told any way, any how.

Finding out by phone is fine by me. I had an HIV test back in the early 90s and was kind of irritated that I had to truck my butt back to the clinic to hear if I was okay. I would have preferred to hear over the phone, so that I could know as soon as possible and I could deal with my immediate feelings alone, not with someone else around. The majority of counseling/education was given at the time of testing anyway -- including what I could expect if I was infected.

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HIV is often handled in a special way because of the history and hysteria that used to surround it and the fact that the gay community was very active and vocal (not saying tthat's a bad thing). Now that HV is not the death sentence it was, we will probably see some of this fall by the wayside. (It already is, with the new recommendations that people "opt out" of testing, as opposed to "opt in.)

What about the consideration that people infected with HIV and/or Hep C need to be told ASAP so they can use precautions to not infect someone else? Or that fact that this population can sometimes be non-compliant (may make an appointment and not keep it, or move and be unreachable). They should be told any way, any how.

Finding out by phone is fine by me. I had an HIV test back in the early 90s and was kind of irritated that I had to truck my butt back to the clinic to hear if I was okay. I would have preferred to hear over the phone, so that I could know as soon as possible and I could deal with my immediately feelings alone, not with someone else.

Yeah, I totally agree about the HIV - result. We have lots of pts come in freaked out because we can't give the result over the phone, regardless of whether it's + or -. as far as your first point, this is a married pt, and pt and pt's spouse both come to the clinic regularly (like, monthly). So non compliance was just not an issue with this one.

I really felt like it was the MD shirking her responsibility and not wanting to be the bearer of bad news. And yes, she wanted the pt to RTC for quant Hep C testing (to determine if the infection was chronic or new), so the expectation was she'd be coming in anyway.

In the future, I will just be having a pt f/u with the provider. I simply don't feel this is with my scope or responsibility to be providing diagnoses, as an above poster said.

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RNfromMN has 4 years experience as a BSN, RN and specializes in Developmental Disabilities, LTC.

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...we will probably see some of this fall by the wayside. (It already is, with the new recommendations that people "opt out" of testing, as opposed to "opt in.)

I've never heard of this - what does this mean? Is the health care profession recommending that people not get tested, or common-folk (if ya know what I mean)?

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Elvish is a BSN, DNP, RN, NP and specializes in Community, OB, Nursery.

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I used to work in a community health center, and we NEVER gave out positive results of any kind over the phone. We called the pt & had them come back to review them...usually if they got labs drawn we made them an appt that same day for 1-2 weeks later for that purpose. We called, and if that didn't work, we sent them a certified letter, or we sent our outreach worker to find them. And we documented all of the above.

I wouldn't feel comfortable giving out results of HIV, HepC, gonorrhea, or shoot, even an ANA titer over the phone. Once you give those results, the patient is very likely to have questions that are best addressed face-to-face and preferably with an MD/NP/PA. JMHO.

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FireStarterRN has 15 years experience as a BSN, RN and specializes in LTC, Med/Surg, Peds, ICU, Tele.

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Maybe when someone gets a test like this, they should be given an option of how they want to be notified. What's so hard about that? I wouldn't want to haul my butt into an office to be told the results of a test. What's so terrible about a phone call from either the nurse or the doctor?

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The law is different and specific for HIV. Those results can not be given out.

As for Hep C and known drug user do you really think this person has the where with all to realize the significance of the positive result? Dealing with these types has taught me they neither understand the Dx nor really have enough self regard to care.

Even most lay people in general really do not have a clue as to the significance of Hepatitis. After it is not a simple disease, drug addicts see their fellow users with the disease and they don't just drop over. They see them living for years with the disease and for many years with no really troublesome symptoms for the person.

No I doubt this will devastate this pt.

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