I need an ER nurse to answer this question for me (pt with HIV related)

Mavrick, BSN, RN · Nov 1, 2015

There's a reason why I hope the ICU nurses at my facility realize a patient has a blood borne virus- a lot of them don't realize that drains/chest tubes are placed from the inside out. I shudder enough as it is as they strip the chest tubes of a patient who just rolled in from the OR without gloves. On a patient with a known virus? I will speak up if they aren't wearing gloves.

I'm talking about the frantic but sometimes whispered notification while I apply a pulse oximeter. Of course you can tell me about an important aspect of the patient's condition in a calm voice during your post op report.

turnforthenurse, MSN, NP · Nov 4, 2015

Yes, everything stays in there. You can look up previous visits on patients on the EMR that include all of the information (triage, VS, PMHx, nursing notes, H&P note from physician, medications, etc). There are some cases when a patient is registered and they are registered under a different account...and in those cases, all of the previous information from previous visits do not flow over. Oftentimes registration will merge the accounts together.

chivon101 · Nov 4, 2015

Yes the records stay in the EMR. I'm so sorry that you received those looks and terribly sorry about some of the comments that are being made. Why would anyone want to come to an ER for treatment and be treated that way, I wouldn't want to tell them either. The only person I would tell is the physician although they can see it any way. I can't stand when nurses do this, then run around telling everyone in the ER about it. It sickens me, you should be more professional than that plus you never know the circumstances on how they contracted it. Our job is to treat our patients, advocate of them, make them feel comfortable. And i may think this way because I've worked in a county hospital where 50 percent have HIV or hepatitis, I take precautions in all patients. No a person should never have to be judged when they come to the ER, especially by a nurse. It's not our job to judge. Again I'm so sorry that you had to deal with that and it made you not want to disclose your status. Just remember that when you become an RN and are caring for other people of different ethnicities, background, economic status. There is know room for judgment, that's our makers job. I hope anyone that gives you dirty looks and tell others that are not involved in your care get it with a big fat HIPPA fine.

Anna Flaxis, BSN, RN · Nov 5, 2015

Your HIV status is protected health information, meaning (in a nutshell) that it is on a need-to-know-basis. You do not have to reveal to me (the triage nurse) that you are HIV+ in triage unless your chief complaint (the reason you are coming to the ER) is potentially related to the HIV- and even then, you are not required to disclose your HIV status. It's just better for you if you do, because we can then provide more appropriate, better care for you.

For example, if you are coming in for a sprained ankle or a cut on your finger, this has absolutely nothing to do with HIV, so it's not relevant information- I shouldn't be touching your bloody fingers without gloves regardless of known HIV status. If, however, you are coming in with a cough and a fever or symptoms of some sort of infection, then this could be related to HIV, so it does become pertinent. Because you have HIV, it is safe to assume that you are at higher risk for infection- infection that a person without HIV might be able to fight off, but that could actually kill you, and this is important to know so that we can move you out of the waiting room as soon as possible and implement protective isolation when you are roomed.

As far as your medications, we do review medications with every visit because medications can change, and what you were taking last time you came in might be different from what you are taking now. Since medications can interact or can cause serious side effects, it's important for the physician to have an accurate list of what you are currently taking.

So yes, there are times when your HIV status is not relevant to your care, and times where it is extremely relevant, and not disclosing could harm you because it prevents proper care from being implemented.

The CNA coming in to check your vitals does not need to know your HIV status (even if you are in protective isolation, all they need to know is that you are in protective isolation- not why). The physician managing your course of treatment does.

As far as drawing blood, as an example, I don't need to know if you are HIV+ or have Hepatitis C, because I practice standard precautions when I draw blood. I assume that everyone has a blood-borne pathogen and I use the appropriate PPE. Even my 100 year old little old ladies. Whenever a patient tries to warn me "I have Hep C, so you should be really careful", I tell them that they do not have to disclose that information just for a blood draw, because anyone who draws their blood is supposed to follow proper procedure and assume that everybody is infected and use appropriate PPE- they do not have any right to know your HIV status simply because they are drawing your blood. Your right to privacy supersedes any perceived "right" to know on the part of the staff.

I once cared for a young man who was HIV+ and came in with a fever and chills. I implemented reverse isolation in order to protect him (it was flu season). I began to explain to him why I was "dressing up in my party clothes" whenever I came into the room, and he interrupted me said "I know, it's to protect yourself from me.". I was floored. I was so surprised that people still think this way in this day and age. I said "No, it's to protect YOU from ME.", and went on to explain that I may be carrying an infection that isn't symptomatic yet and that my clothing touches potentially contaminated surfaces during the course of my workday, and so I needed to be very careful not to infect him because of his immune compromised state.

As I was preparing to insert an IV, he told me I should double glove because he didn't want to infect me. Again, I explained that I was taking the same precautions that I take with everyone, and that I wasn't afraid of him because he had HIV.

What the experience taught me was that people can have misconceptions about the way they are being treated, and if they don't speak up, the caregiver may never know. So please, don't be afraid to ask questions. If you want to know what a caregiver is doing and why, please ask!

Of course, it's best for the caregivers to explain their actions and rationales so that the patient doesn't have to ask, but in the real world, we get busy or we assume that the patient already knows, and so we fail to communicate. Your post is a good reminder about that.

JustaGypsy · Nov 13, 2015

acim, LPN

I'm sorry that you are feeling this way. As other posters said they do indeed keep records. They must. I'm with ktwlpn, this needs to be addressed with the hospital as well as with yourself...

Nicely stated, acim, LPN.