HIPAA and Advocate for competent patient

[akn1563]

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.

[Dana L. C.]

I had a similar situation, face to face with a patients friend. She was at our facility visiting while the patient was being transferred. She immediately started asking questions and became very upset but I refused to put my license on the line to please her. The HIPPA rules are very clear. Its our job as nurses to ensure they are followed.

[Altra, BSN, RN]

This is easy-peasy ... that info cannot be shared over the phone. If a patient is A & O, I always defer phone calls to the patient. If they have A&O family with them - that's my second choice. "So and so has called the nurses station - can one of you come take the call, please?"

And please, PLEASE remember that patients are not always OK with family member discussing the fine details of their care. What young adult really wants his/her aunt to be discussing the color of his/her urine? But it's an easy out for them to just not answer questions, without damaging their relationships - and let the nurse, who they will likely never see again, take the heat.

And ... WHERE do these nurse family members come from, who think that their licensure means they are entitled to a detailed shift-to-shift report? UGH.

[applewhitern, BSN, RN]

Even if you walk into the patient's room and ask "Is it OK if I talk to so-and-so on the phone" you have NO IDEA who is really on the other end of that phone! It could be the patient's attorney or a newspaper reporter for all you know. If someone wants access to information at my facility, they have to go through the medical records department. I would rather risk making someone mad at me, than be sued for violating the patient's privacy.

[MunoRN, RN]

Even if you walk into the patient's room and ask "Is it OK if I talk to so-and-so on the phone" you have NO IDEA who is really on the other end of that phone! It could be the patient's attorney or a newspaper reporter for all you know. If someone wants access to information at my facility, they have to go through the medical records department. I would rather risk making someone mad at me, than be sued for violating the patient's privacy.

I'm confused how that works, lets say you have a patient where the POA is the decision maker, you refer them to medical records when they call?

[applewhitern, BSN, RN]

We don't discuss the patient on the phone, period. They have to be there in person, unless they have a code to identify themselves with. Yes, if they want to see labs, physician progress notes, etc., they have to go thru medical records. Anyone can call and claim to be a relative or POA; how do you know who is really on the phone?

[JustBeachyNurse, LPN]

In my area specific identifiers (MR# , code word ) etc are required for phone updates on condition but full report is not given over the phone to callers.

[MunoRN, RN]

We don't discuss the patient on the phone, period. They have to be there in person, unless they have a code to identify themselves with. Yes, if they want to see labs, physician progress notes, etc., they have to go thru medical records. Anyone can call and claim to be a relative or POA; how do you know who is really on the phone?

So if a patient's POA can't be there in person then they aren't the POA?

[applewhitern, BSN, RN]

If the POA cannot be there in person, no, we cannot discuss the patient over the phone ~if THEY call US~ because we have no way of knowing who is actually on the phone. WE can call THEM, however, if the doctor requests it and/or we need a phone consent for something. Usually if a patient is incapacitated, they have a POA who is nearby. We are simply following HIPPA, and not just making up our own rules.

[ktwlpn, LPN]

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.

Then good for you for not sucking up various staff member's time for a ridiculous reason. You are one of the few in my experience.Nurses I have worked with for years have been some of the most unreasonable family members when their loved ones have been in the care of others. People who have no excuses-except that maybe they think the rules don't apply to them? And it's a sad comment on health care to think that the only safe patient is one with a nurse in the family to communicate for them. Isn't it our duty to give patients and their loved ones the information they need to heal and stay healthy in a dialogue that they can understand? We have to learn to speak to them on their level, we educate over and over and over.That's what we do.

[Esme12, ASN, BSN, RN]

If the POA cannot be there in person, no, we cannot discuss the patient over the phone ~if THEY call US~ because we have no way of knowing who is actually on the phone. WE can call THEM, however, if the doctor requests it and/or we need a phone consent for something. Usually if a patient is incapacitated, they have a POA who is nearby. We are simply following HIPPA, and not just making up our own rules.

First it's HIPAA not HIPPA and there are not HIPAA requirements that say the POA has to be in person. Your facility has interpreted HIPAA their way and instituted policies accordingly which you must follow as an employee of that facility.

There is NOTHING in HIPAA that states information cannot be released over the phone. Information can be released with the patients permission. This is an interpretation of HIPAA regulations and yes they are making up their own rules on how they feel HIPAA regulations are complied with at your facility.

HIPAA states what must be done...how each facility does this is their interpretation and facility policy.

[Susie2310]

My legally competent family member was recently hospitalized. I am the POA and in addition to the POA I have an authorized statement signed by my family member and witnessed and notarized by a lawyer according to the laws of my state that grants me the powers to advocate for my family member's health care needs even if they have not been determined to be incompetent. It authorizes release to me on my request all of my family member's medical records, pursuant to HIPAA. It specifies that my family member intends me to be dealt with by their health care providers, as required by law, as they would be dealt with themself regarding protected health care information.

I telephoned the nurses station from home and told my family member's nurse who I was and why I was calling. I had been by my family member's bedside for most of the day and night and had previously spoken with the nurse. I am happy to say I didn't need to resort to saying I would scan and e-mail the POA and the other document (the former of which was on file) if that would suffice for them to identify me. If anyone, whether nurse or administrator had refused to talk to me or give me information I was entitled to receive about my family member, I would have called a lawyer as soon as I could.

[ktwlpn, LPN]

HIPAA states what must be done...how each facility does this is their interpretation and facility policy.

I remember way back when in the LTC when the whole HIPAA thing started our former DON decreed that this meant the residents names could not longer be on the wall outside of their door.Thankfully some of the other staff talked her back off of the ledge.