Patient Confidentiality...

[CABG patch kid, BSN, RN]

Hello all, I am a graduate nurse, taking boards next week and starting a new job in telemetry in a few weeks. I have had experience as a student nurse tech at a different hospital than the one I will be working at soon.

My question is regarding how much info we can tell family members of the patients. Yes, I have read HIPPA a billion times, but it seems there are so many gray areas. For example, at my old job, I had a patient that was dying of cancer. He slipped in and out of awareness, sleeping most of the time. On the day he decided to withdraw treatment, he had some friends come visit. While he slept, the friend asked me, "What's going on with him? He doesn't look so good. Is he going to be okay?" And what do you say? You can't really say "No, he's dying, he is withdrawing care" and no doctor is going to want to come talk to some random friends of the patient, the best thing i could think of was to have the friend call a family member to discuss the patients condition.

This is just one example.... Overall, I guess I'm afraid of giving out too much info about the patient, but sometimes the family members get you in a bind.... One lady asked why she couldn't talk to her dad on the phone, well, he was on Bipap, am I allowed to even say that? Does everything just need to be referred to the doctor if the patient can't tell me what's okay to tell their family? What about facts.... For example, the patient's condition changes and we begin to take interventions in front of the family. Do we explain to the family what we are doing if they ask or just ask them to hold their questions while we concentrate???? I know someone else asked a similar question regarding lab test results and things like that.... Sometimes its tough because nurses know a lot of information, but they I think we're supposed to pretend like we don't know a lot of stuff the doctors have to explain :icon_roll

Maybe I am just being paranoid, I know how crazy HIPPA is these days and I don't want to step outside my scope of practice here. How do experienced nurses handle these situations?

Sorry this post is so long, but this has always been an issue for me

[TazziRN, RN]

Safest answer unless you know absolutely for certain that the pt wouldn't mind if you said anything is, "I'm sorry, you'll have to ask the family. I can't discuss pt issues with anyone but the pt and family." You NEVER EVER EVER discuss pt issues with their friends, and you don't even discuss them with the family unless the pt has given permission.

[Ruby Vee, BSN]

safest answer unless you know absolutely for certain that the pt wouldn't mind if you said anything is, "i'm sorry, you'll have to ask the family. i can't discuss pt issues with anyone but the pt and family." you never ever ever discuss pt issues with their friends, and you don't even discuss them with the family unless the pt has given permission.

i'm with tazzi. if the patient wants to discuss his condition with random friends, his pastor, his long-estranged daughter or the anchor from the local tv news, that's fine with me. but i don't discuss his condition with anyone except the patient and his immediate family. (and no, his uncle from china, his "favorite cousin" and his mistress aren't immediate family!) i'd refer the friends to his family.

i don't give out the family's phone numbers, either, unless they've indicated that would be ok. i figure if someone is close enough to the patient to need to know his condition, they already know how to contact his family!

[CABG patch kid, BSN, RN]

So then it is okay to discuss the general condition with immediate family? I'm sorry, I've just had a lot of patients with dementia or they were so out of it they didn't really know what was going on, so I guess my question was more for if you don't know what the patient wants. I suppose in those cases, I could discuss things with the family member that was in charge of making the medical decisions and if all else fails, just say "You'll have to discuss that with the doctor".....

I'm probably worrying about it prematurely, if all else fails, I will talk to my preceptor about it in more detail in a few weeks.

Thank you for the responses!

[TazziRN, RN]

So then it is okay to discuss the general condition with immediate family? I'm sorry, I've just had a lot of patients with dementia or they were so out of it they didn't really know what was going on, so I guess my question was more for if you don't know what the patient wants. I suppose in those cases, I could discuss things with the family member that was in charge of making the medical decisions and if all else fails, just say "You'll have to discuss that with the doctor".....

I'm probably worrying about it prematurely, if all else fails, I will talk to my preceptor about it in more detail in a few weeks.

Thank you for the responses!

No, it's not okay to talk with even the family without the pt's permission, but most families have permission from the pt. If the pt is demented, even if there is no DPOA assigned, docs will almost always discuss it with the spouse/children/siblings of the pt.

When I worked ER and would get calls about pts, I always put the caller on hold and went to ask the pt "What do you want me to say?" This was before a portable phone was obtained and I could put the pt on the phone.

[dream'n, BSN, RN]

I feel your pain. HIPPA (or is it HIPAA? I've learned how to spell it a thousand times only to forget in 5 minutes, all I ever remember is Healthcare Insurance Portability something, something) is a mess of gray areas. It has a million problems actually being effective in real life, since every patient and their situation is unique. Anyway just be smart, remember to always treat your patients privacy and confidentiality with the upmost respect, and if in doubt, err on the side of privacy and you should do just fine.