Is this against hippa?

mstacyi · Jul 13, 2013

Sorry for typos and run on sentences, i am stress and typing from my phone.

Meriwhen, ASN, BSN, MSN, RN · Jul 14, 2013

It's a HIPAA violation if in your example, you talk about a patient's care in a way that that patient can be identified.

If you say something like, "In similar cases, I've seen the doctor start off with X, Y and Z," that's not a HIPAA violation.

That being said, you want to keep your scope of practice in mind and not step out of it. I may say "I've seen the doctor try X or prescribe Y" but I'll always add, "but that's something you and the doctor will have to discuss."

And it's always good to educate your patients. It's best if you can provide the education (explanation, handouts, etc.). Though if you suggest the self-education route...the fact is that most of them are going to turn to Google, not the public library. There's as much misinformation on the web--if not more--than there is accurate information, so make sure you advise them to go to reputable websites sites such as WebMD, the CDC, etc., to do their research.

As far as alerting relatives, I tell them that due to HIPAA regulations, we can't do it and this is something that they will have to do. Yes, I could say that we'd call if they were willing to sign a release of information for everyone they want us to talk to...but to be honest, the doctor and I have more than enough to do without having to call extended family with patient update bulletins. If the patient is AOx4 and they're got family visiting them every day or thereabouts, then THEY can call Uncle Billy and Great Cousin Sue in Montana and give them the 411.

psu_213, BSN, RN · Jul 14, 2013

When patients ask us what are the treatments for their condition, can we say "from my experinces i usually see this things and steps being done." not to say they will get the same treatment as everyone else in their condition, but this is what i usually see being done.

If you do nothing to identify another pt (their name, birthday, etc.) you have no HIPAA issues, so, on that front, it would not be an issue to tell a pt "this is how it's usually treated".

However, I would be very careful with telling a pt what is "usually" done. A nursing colleague was once telling a pt with a fib about the tx. options. Well, the questions from the patient were "will the cardioversion hurt? "what is its success rate? " "what are the complication from an ablation?" "what percentage of ablation pt's have that retro [peritoneal] bleeding?" etc. etc. The patient volleyed a bunch of questions at the nurse that she was not prepared for and she was not qualified to answer.

jadelpn, LPN, EMT-B · Jul 14, 2013

"Please write down any questions or concerns you have, and the doctor can answer those for you, as well as treatment options". You can get into hot water no matter how well meaning a "well, I have seen" scenarios.

You should have patient education that you give all of your patients regarding their conditions. I never suggest internet diagnosing and treatment, as one can induce panic when there needs not be, as the sources are not always trustworthy.

If a patient is A&O, then the children do not need to be in the know unless the patient wants them to be. All patients have the right to privacy. If the kids call, they can be connected to the parent (if the parent would like them to be) and the parent can discuss condition with the kids should they choose to do so. I would not suggest "best time to call" situations, as it puts everyone in an awkward position, as a number of patients do NOT want their kids to know everything. And that is their right.

I would be careful in the information that you offer that is not reflected in the educational material that you give to patients. I would further be careful of getting involved in the kids need to know. The last thing you want to hear is "nurse mstacyi told us that you usually treat this with xyz" "Why are you not doing that for Mom?" "Is she not as important as your other patients?" And there may or may not be numerous contraindications on why some treatments are not feasible.

Bottom line, offer support and encouragement to the patient, educate the patient, otherwise, stay out of the family issues.

mstacyi · Jul 14, 2013

Thank you everyone for giving me your input. I didn't think I was doing any thing wrong other then giving my care and advising them of how to better prepare themselves for answers and questions. I have been lurking here and there for privacy rules and how to better handle converstations like this again.

nurseprnRN, BSN, RN · Jul 15, 2013

1) I hate it when nurses turf a patient question off to another discipline. Interestingly, so does NCLEX, and there's a good reason for that. The patient probably wouldn't be asking if his physician had done a better job of explaining, or if he hadn't been too anxious to take all of it in when the physician did explain. NCLEX wants to know what the nurse will do, not what someone else will do...and assumes that as a nurse you WILL do something useful and therapeutic for your patient. So, using the time-honored response that is rewarded by NCLEX for a good reason, your response should be, "What did your physician tell you about this already?"

2) Then you have the opportunity to clear up any holes in your patient's knowledge, like what a prep will involve (another thing NCLEX tests you on, and with more good reason), dietary or other precautions involved with a plan of care, what usual pre- and postop care involves (if surgery is in the medical plan of care), or whatever else is involved.

3) NOW you have an excellent opportunity to teach the patient to write things down "for next time, and when you go into the office." You do this after you have had the above conversation because now the patient realizes you know what you're talking about, realizes that you are his advocate, and trusts your recommendation. It will also be there when you go in the next day and say, "Did you think of anything else you needed to ask?"

4) Last, you document all this and tell the physician that his patient has concerns and questions about X, y, and z, and you have told him thus-and-such but he needs to hear it from his physician too. Often docs don't realize that they aren't being very clear about their instructions or explanations to patients (imagine that!) and this might help the doc amend his style.

5) Totally not a HIPAA issue unless you are saying something like, "Mrs. Smith, your roommate, had the same surgery and ..." Patient teaching as outlined above is never a HIPAA issue; it is a prime nursing responsibility to assess patient knowledge and do health teaching about care and recovery.

mstacyi · Jul 15, 2013

I have forgotten all about nclex which I now relaize that I have venture away from the perfect nursing world.

I have encourage clients to ask the doctors questions and be prepare with questions, but guess my client mistook me for not answering any of their questions after I told them "this is what i usually see happen in other clients who may have the same diagnose." I now learn to not say anything even if I may know what is usually being done.

I didn't document anything that was said down because it was a whole bunch of I can't discuss labs, test results, and doctor's notes with you. I am curious now how can I be more accurate in writting in the pt's chart telling the doctor that pt have questions and questions about x, y, z? I have always passed it on to the day nurse to get the primary doctor to come talk to the pt.

I didn't mention anyone name in my converstation, but we have cohort rooms so privacy is pretty much out of the picture. Every discussions you have or noise you make the other client will hear it. The only privacy the client will get is when the drapes are pulled for changing and dressing.

Between thanks for your reply, it really have given me hope and ideas on how to manage future issues as this.

nurseprnRN, BSN, RN · Jul 16, 2013

Not sure what you mean by "venture away from the perfect nursing world." Any RN can collect information from any patient. I'd just encourage you to work off of what your patients say to you before discussing what you've seen with other ones. That doesn't mean you can't share your experience or your knowledge about labs, surgeries, etc.; nurses need to know those too, and it's perfectly appropriate to share that knowledge with your patients (without identifying other specific cases, of course). For all the mockery of NCLEX being unrealistic and in a perfect world, that truly doesn't mean that we can't strive for the best care we can give, and that includes patient teaching. There is an awful lot of NCLEX's "perfection" that is perfectly within reach of any nurse who cares to give it a shot, and I thank you for providing a very good example of that.

As to charting, it is perfectly appropriate and professional to chart something like, "Patient educated on protocols for usual preop preparation for total knee replacement, postop care and assessment, and physical therapy in response to her questions. Encouraged to ask Dr. Smith her specific questions about anesthesia agents, antibiotic coverage, and surgical team members on rounds in a.m."

This documents that you have assessed her knowledge deficit and addressed it within your scope of practice, and have referred issues within physician scope of practice (medication prescription, choosing surgical assistant) to the physician.

mstacyi · Jul 16, 2013

Thank you so much on your input and advises GrnTea. I will try to better my documentations and proceed issues like this with more attention next time. With what i had to deal with in the last few weeks, had really got me curious and want to be the nurse I think I am.

BlueDevil,DNP, DNP, RN · Jul 22, 2013

When it comes to gathering info from the internet, I tell patients to ONLY consider information gathered from sources that are (dot)gov or (dot)edu. Anything else must be considered unreliable.