HIPAA and Advocate for competent patient

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  1. Was I right to not give information?

    • 15
      Yes, I had to protect patient privacy
    • 0
      No,The family should be informed

15 members have participated

I have been an RN for about a year and a half now and I have recently started on days on a cardiovascular step down unit. I had a 29y.o patient who was completely alert oriented and competent. A patient's family member (aunt) called at the end of the shift to have a "detailed report of what happened" with the patient that day. I said to the "aunt", "I apologize, but unfortunately I am only able to tell you that the patient is here and that he is stable" This is what I had been told since day one of nursing because you can never truly verify who is on the phone even if a password has been created. She was very curt with me and stated that she was a nurse and was his proxy for healthcare and that she had been receiving information all along and why would I say this now? I explained that with her being a nurse she should understand that because of HIPAA it is difficult to verify who she is and the patient is alert oriented and competent and so she is unable to receive information about the patient unless the patient tells her then I offered to transfer her to the patient's room phone which she refused and asked to be transferred to the charge nurse. I thought the issue was resolved after the charge nurse reinforced what I had said and was then transferred to the MD. The next day the stepmother and girlfriend were upset (which I knew nothing about) and called Patient relations, and our manager, and supervisor because of this issue. I had my superiors stand by me, but I am still unsure what to really think and what is right. The aunt wanted to receive information such as lab values, radiology studies, tests, what the plan was, and then silly things such as how many times was he OOB and how many times did he urinate and what color was it (she literally said that). I understand she is concerned, but with my license on the line and HIPAA what am I supposed to do??????

Sorry for the long story.

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Specializes in Critical Care.

If the patient is competent why don't you just ask the patient if you can share information with so-and-so?

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Specializes in Pediatrics, Emergency, Trauma.
If the patient is competent why don't you just ask the patient if you can share information with so-and-so?

Better yet, the aunt could've just been transferred and found out from the patient. :blink:

OP, what you did was appropriate, and even better, your healthcare team stood by it.

People can be unhappy and complain; however, they have to respect the rules and the professional integrity we have to maintain. :yes:

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I recently went through this with my Uncle when he was critically ill....before he passed this past summer. My family wanted my sisters and I to talk with the MD's and try to get a handle what was going on. we had to go through Nursing services and the MD's on my Uncles case...document written permission from my Uncle's family and discussed his case by conference calls.

I never requested the nurses to give me information without going through administration.

This nurse the OP is talking about was out of line.

You did good.

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The patient never had anything to say when anyone was in the room and he said he couldn't relay any info (even the OOB and urination part) it was frustrating

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Specializes in Pediatrics, Emergency, Trauma.
The patient never had anything to say when anyone was in the room and he said he couldn't relay any info (even the OOB and urination part) it was frustrating

It's frustrating....BUT...he has a right to maintain his privacy...and you ADVOCATED for him!!! :up: You are prepared the next time a similar situation arises. :yes:

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Specializes in Critical Care.

It's up to facilities to determine how they verify the identity of someone who's allowed to receive information, the spirit of the rule requires a reasonable attempt to confirm identity without excessively burdening the sharing of information when it's appropriate. Some patients are particularly uninvolved in their own care and certainly benefit from a third party advocate, so it really makes more sense to for Nursing to make an effort to involve these advocates as much as the rules will allow, rather than keeping them as uninvolved as the rules will allow.

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Specializes in Hospice.
Some patients are particularly uninvolved in their own care and certainly benefit from a third party advocate, so it really makes more sense to for Nursing to make an effort to involve these advocates as much as the rules will allow, rather than keeping them as uninvolved as the rules will allow.

I agree that sometimes a 3rd party advocate (especially with a nursing background) can be beneficial, but in the case of a 29 y/o alert/ oriented and competent patient should be initiated by the patient.

I've run into this situation in geriatrics and unless the appropriate consents/ documentation are in place, I give the same response as the OP. It frustrates me when "complaints" by persons who are declined info take up time (nursing supervisor, physician, management etc). Especially when it is a person in the medical field (a nurse for example) who has knowledge of HIPAA.

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Specializes in LTC,Hospice/palliative care,acute care.

It would have been very easy for this patient to make this aunt (supposed nurse) his contact and all of this could have been avoided.In my experience these people are seldom real nurses-they are MA's,CNA's (years ago) or answer the phone in a physician's office or run the register in a pharmacy. Once in a great while you are talking to a real RN-but she/he hasn't practiced as a nurse for 20 years .

The stepmother and girlfriend' actions are ridiculous,too.What a waste of everyone's valuable time.

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Specializes in Pediatrics, Emergency, Trauma.
It would have been very easy for this patient to make this aunt (supposed nurse) his contact and all of this could have been avoided.In my experience these people are seldom real nurses-they are MA'sCNA's (years ago) or answer the phone in a physician's office or run the register in a pharmacy. Once in a great while you are talking to a real RN-but she/he hasn't practiced as a nurse for 20 years . The stepmother and girlfriend' actions are ridiculous,too.What a waste of everyone's valuable time.[/quote']

I am a healthcare proxy for a few of my family members because I am the only nurse in my family-before your ask; I am a practicing, licensed nurse-I NEVER overstepped a nurses practice when it came to caring my family members, or demanded that they breach HIPAA.

I remember my mother calling me at 7AM on a Saturday morning after working a dog tired week of work, because she didn't want to take insulin because she is NIDDM; I gave her the layman's reason and hung up; I even felt bad she called me in front of the nurse!

I went up to the hospital a few hours later-my mom was letting EVERYONE know that I was a nurse- :no: OH, I don't like for people to know that I am a nurse, unless it becomes revealed-for example, as a pt, they ask for occupation....I am one of those family members who will let a nurse do their job, and get the info later from a awake, alert, oriented family member. If I know the healthcare team needs to speak to me, then I am prepared; otherwise, I will only step in IF they cannot speak for themselves or it's a major decision and even then, they still have a right to make their own decisions. Otherwise, I'm not asking about poop and any other issues. :no:

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as a soon-to-be nurse, can I ask why not go into the pateitns room, ask him if you can talk to so-and-so and address it that way? I'm asking because that's probably what I'd do and want to see if that is an acceptable practice

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Specializes in Complex pedi to LTC/SA & now a manager.
as a soon-to-be nurse can I ask why not go into the pateitns room, ask him if you can talk to so-and-so and address it that way? I'm asking because that's probably what I'd do and want to see if that is an acceptable practice[/quote']

The other big issue is how do you know for certain the person on the phone is who they claim to be? When my father was critically ill quite a few of over curious liars, I mean "acquaintances" would call seeking information about my father's diagnosis, condition, and prognosis. One trying-to-be-helpful staff member was a bit too forthcoming with info and was overheard by one of my siblings. It was someone claiming to be one of my father's siblings too bad both his siblings were there as were my mother and all his children. Administration was involved shortly thereafter.

The better option, which the OP DID offer (assuming patient is awake. & alert) is to transfer call to the patient. The "aunt/nurse" in the OP refused this option.

.

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