Patient fell and doesnt want family notified

[Mrs.in2015]

Hi everyone. So I had a rehab patient fall. She asked that I not tell her family. I alerted the doctor after assessing the patient (just a couple of minor skin tears, no other injuries). MD came out of room and said the patient is of sound mind, refused a CT, and doesn't want the family informed which is her right by law. Easy enough, I continued to monitor the patient throughout the day.

Fast forward to end of shift. the family shows up, notices the skin tears and asks me if she fell because they are concerned she fell and forgot about it but she swears she didnt fall. I awkwardly educated them about the blood thinners she was on (how they cause high risk for bleeding and easily bruising, etc.) And assured them she had not been confused. Basically I didnt say "she did not fall", but i led them to believe she didnt. And now I feel like scum. Did I do the right thing?

[JKL33]

I wrote a bunch and erased. Will summarize: No, I generally do not take the risk of having my motivations or intelligence questioned in a situation that has nothing to do with me. I am pretty straight-foward; kind, but straight-forward.

I would have stated, "I'm sorry, but I am not permitted to discuss that." If they pressed me, I would refer them to the physician or nursing supervisor. I would reassure them that I will pass on their concern about the possibility that the patient has fallen.

(BTW, I probably would also talk to the patient a bit more in private. They do have a right to make decisions about sharing information - - but it's worth investigating whether they believe their choices are going to help or hurt them in the long run.)

[Jory, MSN, APRN, CNM]

I probably would have told them, "The skin of seniors is fragile and can sometimes tear from various movements. Blood thinners can make injuries that wouldn't show up on you or me, more visible". This provides information yet completely dodges their question.

If the patient is of sound mind, you were correct in honoring her request.

[kp2016]

Your patient is an adult of sound mind so her medical information is private and she has every right to not share it with her family. Educating them on blood thinners was a smooth move but I would probably have also educated them on HIPAA.