Privacy/Patient Info

Anaclaire · Apr 5, 2003

I like this thread. It's great to learn how other people do things and to find out ways we can possibly improve our own places.

Our hospital allows two armbands per baby. This means that when a baby is admitted, it's Mom and one other person she designates to each receive an armband which has the baby's computerized stamp plate information on it. They must wear the armband until the baby is discharged. This is their ticket into the NICU.

Sometimes the Mom wants the Grandmother to have the extra armband rather than the baby's father (some Dads sadly aren't involved... or only minimally). Sometimes the Mom or extra person has a job where they can't wear armbands due to machinery, etc. In that case, we put the band around their ankle.

They don't seem to mind being banded... it's kind of like a badge of honor.

Each banded person may bring in one extra person at a time. So, if Grandma has the extra band, she can bring in Aunt Sue. The understanding is that the Mom is aware of who has the extra band and works out her desires about who should be allowed to visit with them. Each baby can have two visitors at the bedside at one time. So, if both banded parents arrive and want to bring in a visitor each, one of them must leave and let one visitor take their place. It's just too much to have more than two non-medical people at the bedside at one time. There are always exceptions of course... like when a baby is very, very critical and the family wants to surround the bed for a prayer, etc.

Our banding policy sure makes it easy for us. Our secretary or whoever lets the people in simply has to see the armband and then will allow the banded person and one other person in at a time.

We only give information about the baby's condition to the Mom and Dad. Even if Grandma has the extra band, she only gets the most basic of information. The Mom is given a paper explaining visitation policies (24 hour unlimited for banded people except during shift change or if something very critical is happening to their baby or a baby very close in proximity to theirs.) and our policy about giving out information.

Our biggest problem is when people call us and want information over the phone. If we aren't sure we are talking to the parents we will tell them we are busy and we will call them back in a few minutes at their phone number on the baby's chart.

Sometimes we have a real problem with other people calling for updates, and being very naughty about things. For example, the girlfriend of the baby's father calling and acting like she's the mom and wanting information! If there is a wierd family dynamic like that happening, we will come up with a "secret word" that we ask the Mom to tell us before we will give her any information over the phone. The only time this became a problem was when a nurse was at lunch break and another nurse answered the phone and gave some info without asking for the "magic word". We fixed that by not allowing anyone other than the nurse caring for the baby to give information.

We have name cards on the isolettes and beds that have the patient's last name. Years ago we'd make large ones so we could see them from far away across the room. We decided to change that to be small again because of patient confidentiality. For a while we considered writing the baby's first name on the cards but that was shot down pretty quickly for good reason.

Once in a while a parent or visitor will become curious about other babies in the unit and begin to venture out to look at other babies... peering into another baby's isolette, etc. We quickly and very tactfully come up to them and tell them they need to stay focused on their own baby.... that we know they are naturally interested in all the babies but that we want each child to have his own privacy... we don't let other people wander around looking at "your" baby when you aren't present. They quickly understand and apologize readily.

As far as information about the baby's condition, progress, plan of care, etc. we always tell people to speak with the parents. Even when the parent is present with a visitor and the visitor asks questions, we will give rather limited information unless the Mom speaks up herself and says, "It's ok, please explain everything." We've had parents later say they really didn't want the visitor to know everything, but they didn't know how to say, "No, we don't want this person to have all the details... we are just too young and have not enough backbone to tell them so."

Our NICU has a window alongside a hallway that leads to the surgery suites. We can bring children to those windows to see babies sometimes. We don't allow any children under 12 to enter the NICU. If the baby's condition warrants, we can physically bring the baby to the edge of the NICU/reception area for the younger siblings to see them for a couple of minutes. We try to take a photo with our polaroid camera for them to enjoy later on. We have had no real problems with this. We all simply have to stick to our guns. The reception area has tile and the NICU has carpet. The "magic threshold" is the carpet. The children can't step on the carpet...

If twins are born, the parents get a total of 4 armbands to dole out. Usually one for each parent and then they can choose two more people. Usually one grandmother on each side gets one... Mom, Dad, Mom's Mom, Dad's Mom. Works out well.

I can't think of anything else to say right now. I tend to talk too much anyway...

Sorry!

neonatalRN · Aug 5, 2003

I know this is an old thread, but I saw that one person said that the parents at their unit have to leave during rounds and report. I don't understand why. Don't the parents have a right to know everything about their baby?

Heidi

dawngloves, BSN, RN · Aug 5, 2003

Annasmom,

It's because you'd also be able to hear rounds on the other babies as well.

neonatalRN · Aug 5, 2003

Oh I see. thanks. With my son I didn't have to leave, but I never paid attention to what was said about the other babies anyway.

Heidi

cindylouwho · Aug 5, 2003

I think HIPPA has changed the info we can give over the phone at least in our unit...

cindylouwho · Aug 5, 2003

also...I wouldn't mind letting parents stay if they would just keep to their baby and talk among themselves but there always is the ones who look right at you and listen to everything said and then have the nerve to ask questions about the other patient....but they also get mad when asked to leave....I just make everyone leave now and who cares if they get miffed....

cindylouwho · Aug 5, 2003

one more thing....if it's 10 minutes before shift change...I don't let anyone in and those holding have to put the baby back and get out....I make them wait till we are done which is sometimes 20 after the hour.....if you start that right away they get used to it...consistancy means alot.....it's not worth my job to let them overhear something they aren't suppose to hear

cindylouwho · Aug 5, 2003

I had an aunt from out of state call and demand info on her niece....I politely told her I wasn't allowed to do that and she told me to "GO TO HELL!!!"....that's the kind of crap we have to deal with.....also the grandma wouldn't leave the baby alone that was having seizures so I tried to calmly explain to her why she shouldn't rub the baby and pat her butt and she told me that her feelings were more important than mine.......I asked her if her getting to touch her granddaughter...causing her to have seizures was more important than the health of the baby?...she just gave me a dirty look.....needless to say I was fed up with that family.......for once my supervisor backed me up on this one....

cindylouwho · Aug 5, 2003

by the way...I called and got an order from the doctor for everyone to keep their hands off this infant till further notice...it's too bad some people are so stupid

cindylouwho · Aug 5, 2003

we don't have a clerk to help us with visitors and there is not time to check everyones ID......so what we do is let anyone come with parents as long as one parent is present.....I don't like it but the way our unit is set up...no clerk most of the time and pods where you can't get out to let them in (locked unit) it's the only way....

NicuGal, MSN, RN · Aug 5, 2003

Hippa has certainly changed many things in our unit.

Cindy...our unit was like that but then because of legality and Hippa we had to change the rules. I can tell you, it is sooo nice not to have a zillion people in and out all day.

NICU_Nurse, BSN, RN · Aug 5, 2003

Wow, Cindy, you sound a little stressed out!

(((((((hugs to you)))))))