Pt told me... why didn't anyone else?

[Blues1220]

I work for a Home health agency, I take care of pts in assisted living facilites. Generally I am given an oral report on pt's condition, medication, needs etc. However this time I was not told that the patient had Hep B&C and Aids.... I have been told these conditions on previous patients in the past. The Pt is the one that told me, and the pt also told me the he was told not to tell anyone...

I feel that this was deliberate and I no longer feel safe in my work enviorment. What should I do?

[I<3H2O, BSN, RN]

Wow! Did he happen to say why he was told not to tell anyone? That is insane. I would definately talk to my supervisor about this.

[merlee]

Why are you accepting oral reports?? You should be on a computer system, and everything needs to be disclosed.

Ask your supervisor to make certain you are being given a full report.

[Blues1220]

The pt did not say. & I would love to go to my supervisor about this however I he/she is the one who told me the info and I cant help but wonder if he/she knew and conveniently left the info out of report fearing that I may refuse because others have in the past.... I just dont' understand how could he/she not know?

[DixieRedHead, ASN, RN]

Did you look at the chart? And if your supervisor had no access to the chart how would he/she know.

[tokmom, BSN, RN]

We were told at my previous place of employment that it didn't matter, because you use universal precautions on everyone.

Where I get annoyed is the fact that theses people may have certain issues that need to be addressed and you don't know what they are if you don't have a full diagnosis.

[nurseprnRN, BSN, RN]

you have no reason for worry about your "safety" if you do standard precautions anyway.

you probably aren't old enough to remember the beginning of the aids epidemic, before universal precautions (now "standard precautions" were first used), but i am. i can tell you that once people realized that anyone's blood and body fluids can carry pathogens well before any diagnosis is made, they stopped worrying so much about the patients whose diagnosis had been made.

put another way, they stopped using a lower level of precautions or care on people who didn't have a hepatitis or hiv diagnosis, because they realized that anyone could have them and not know it. go thou and do likewise, and get over yourself.

[sweetnurse63, BSN, RN]

you have no reason for worry about your "safety" if you do standard precautions anyway.

you probably aren't old enough to remember the beginning of the aids epidemic, before universal precautions (now "standard precautions" were first used), but i am. i can tell you that once people realized that anyone's blood and body fluids can carry pathogens well before any diagnosis is made, they stopped worrying so much about the patients whose diagnosis had been made.

put another way, they stopped using a lower level of precautions or care on people who didn't have a hepatitis or hiv diagnosis, because they realized that anyone could have them and not know it. go thou and do likewise, and get over yourself.

although standard precautions should be used for every patient, all nurses have a right to know the diagnosis.

[canesdukegirl, BSN, RN]

I am confused. The pt didn't just contract HepC/B and AIDS on the fly. This should be in the pt's chart long before you took on his care. Why was this not reported to you? Surely the other health care providers knew this.

Yes, universal precautions should always be implemented, but an adequate report requires informing the on-coming health care provider of the pt's basic H&P. This should have been reported to you.

What if you were reviewing the MAR without the knowledge of his HIV status and miss a contraindication for meds that are written? What if this pt was in a clinical trial and you unknowingly administer a medication that is outside of the guidelines of the clinical regimen?

What if you administer a drug that is hepatotoxic?

It is not only unethical to receive an inaccurate report that omits the conditions that you describe, but also DANGEROUS for you to be uninformed of this patient's co-morbidities. The legal consequences alone make me shudder.

We can't very well provide safe and effective nursing care if we don't have all the pieces to the puzzle.

I feel badly for you because you were put in this position. AND for the pt, who was told that he can't tell anyone. That is horrid.

What are you contemplating as your next step?

[Blues1220]

Without getting into too much detail... The pt is new, it is a small facility and the home owner is not always quick with the paperwork....so there is no chart at the home yet.

& We are a small agency and though i would love to be on a computer sysytem that is not the case, therefore oral is what we got...

I have taken care of pts with these diseases before; that is not my issue. And yes I take percautions. But what concerns me is the level of trust that I have with my co-workers, supervisor and home owner.... at all other times I was told of the patients condition. What was different this time?

[Esme12, ASN, BSN, RN]

Why are you accepting oral reports?? You should be on a computer system, and everything needs to be disclosed.

Ask your supervisor to make certain you are being given a full report.

I'm curious.......Does home health have computer systems?

[classicdame, MSN, EdD]

Universal precautions would make this a non-issue if you are concerned about yourself. HOWEVER, reading the chart is required to know how to appropriately care for the patient.