Question about HIV and patient confidentiality

NursesRock!! · Jun 13, 2008

It's my understanding that anyone involved with direct care of siad patient has a right to know their diagnosis etc. . . Correct me if I'm wrong. . . I don't think what she did was wrong- I'd want to know. Suppose you got a needle stick or something, knowing in advance would cut out time for other red tape. JMHO

CABG patch kid, BSN, RN · Jun 13, 2008

If you want to approach this as a teaching opportunity (although it may not be welcomed), I think you should approach the RN directly rather than going straight to the compliance officer. In that situation, I probably would have said something like "Oh? Well I use the same precautions with all my blood draws so the patient's confidentiality is protected, but thanks for the heads up". That way you're mentioning the confidentiality issue but not making it feel like a confrontational situation. On the other hand, if this RN is just blabbing it around to everyone, then it needs to be addressed very quickly. I guess it depends on the severity of the situation. Maybe I'm wrong, I'm curious to see what others say.

I also wanted to add, regarding the second post, I think that unless the patient's current hospital admission is for treatment or management of an HIV related issue, it is kept confidential and no one needs to know. That's why we use universal precautions. As far as I know, HIV is the only disease process protected by this law. Hep. C is common knowledge to all involved in care from what I've seen.

ijuanabhappy, ASN, RN · Jun 13, 2008

I agree with NursesRock. I would have appreciated a heads-up on something like that. You are both direct caregivers of this patient. The RN was in my view being considerate and just telling you for extra precautionary measures. I don't see that as any violation, but I could be wrong. I would definitely not report her. Its not like she was just trying to gossip about the patient's status.

Okami_CCRN, BSN, RN · Jun 13, 2008

Its not a matter of confidentiality being breached because you as a phlebotomist have become involved in the said patient care plan and so should rightfully be made aware of any conditions that could jeopardize your safety and health.

I think the RN was being rather thoughtful in warning you the patient had an HIV infection.

traveljen · Jun 13, 2008

i think it is a HIPPA violation because she didn't need to know this information to due her job. When you draw anyone regardless of if they have anything or not your supposed to treat it as if everyone does. I might not report it to compliace officer i would tell my manager and ask what they think I should do.

lil' girl, LPN · Jun 13, 2008

hmmmmmmmmmm sounds like you "told" someone else too.

EricJRN, MSN, RN · Jun 13, 2008

It may have been a gesture that originally had good intentions on the part of the nurse, but those intentions were misguided.

We're exposed daily to conditions that could theoretically jeopardize our health and safety. That's why we take so many precautions with each patient (wear gloves, wash our hands, don't kiss 'em, etc). Specifically in regaed to HIV, prevention doesn't require anything more than following standard precautions.

NursesRock!!: How would knowledge of a patient's diagnosis affect the timeliness of infection control/employee health procedures?

Virgo_RN, BSN, RN · Jun 13, 2008

I'm working in the lab of a large hospital while waiting to start the nursing program at my local community college this fall.
I was on phlebotomy tonight and before one of my draws the patient's RN pulled me aside outside the room (in the hall) and told me to "be careful because she's HIV positive." Another phlebotomist related that the RN had also advised him of the patient's HIV status before he drew the patient earlier in the evening.
As a phlebotomist, you'd have to be point-blank stupid not to approach every draw as if the patient had a blood-borne pathogen. That's why we have things called personal protective equipment and universal precautions. A patient's HIV status is and should be irrelevant when it comes to drawing blood since you should be taking the same degree of precaution with every draw that you do.
I believe that the RN needlessly compromised the patient's right to confidentiality, especially with such a highly confidential diagnosis. In addition to what seems to be to be a serious breach of ethics on the part of the RN, it also sounds like a big, glaring HIPPA violation.
I'm not even in RN school yet and it's setting off alarms with me. Am I off base in my assessment of the situation? I'm seriously considering reporting it to our compliance officer, my motivation not being to "nail" the RN, but rather to take advantage of the situation as a teaching opportunity for the RN, and also advocate for the patient who probably has no idea that her confidentiality was breached.
Any thoughts from you seasoned professionals would be most appreciated!

I'm in agreement with you. You have no reason to know the patient's HIV status. Is there a way you can bring the subject up through the right channels without singling out the individual nurse?

pedicurn, LPN, RN · Jun 13, 2008

Need to factor in :

risk of human error. Easy to make a mistake when an RN is overworked, tired from shiftwork, hasn't had a break, balancing MULTIPLE responsibility.

I wouldn't report the RN - sounds as if she was discreet about it.

When a coworker tells me these things, I am thankful.

By the way, isn't it time we treated HIV status the same as we do HCV or HBV?

Atheos · Jun 13, 2008

Need to factor in :
risk of human error. Easy to make a mistake when an RN is overworked, tired from shiftwork, hasn't had a break, balancing MULTIPLE responsibility.
I wouldn't report the RN - sounds as if she was discreet about it.
When a coworker tells me these things, I am thankful.
By the way, isn't it time we treated HIV status the same as we do HCV or HBV?

The law specifically states that only people that would have the right to actually see that information in the chart can know. CNA's, phlebotomists and other nurses have no need or right to know. The only time people need to know is when it is necessary for proper care. The primary nurse needs to know in case anything is going on with the patient. The doctor needs to know so they can utilize proper treatments, etc. It is not a debatable idea. It's a law.

We can not treat HIV like any other disease because there is still widespread discrimination against HIV patients.

That nurse and anyone else that tells is breaking the law.

pedicurn, LPN, RN · Jun 13, 2008

The law specifically states that only people that would have the right to actually see that information in the chart can know. CNA's, phlebotomists and other nurses have no need or right to know. The only time people need to know is when it is necessary for proper care. The primary nurse needs to know in case anything is going on with the patient. The doctor needs to know so they can utilize proper treatments, etc. It is not a debatable idea. It's a law.
We can not treat HIV like any other disease because there is still widespread discrimination against HIV patients.
That nurse and anyone else that tells is breaking the law.

IMHO it's time we challenged that.

We have that law here too and i privately consider it to be a violation of my rights. I am entitled to know if a p't poses any threat to my health/wellbeing in any (even remote) way. I am entitled to be fully informed.

If my P't is HCV it is considered acceptable to wear different gloves to take blood

as an RN...noone takes issue with that.

As well as being entitled to be fully informed about all potential risk to myself in my workplace, I should be fully informed about my p't.

To use the HCV example again - I am expected to know that my p't is HCV even if unrelated to admission. It is considered an omission if I don't know this.

It's time HIV was treated in the same way and we got rid of this paternalistic nanny state law!!!