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!
Angelfire, I am not questioning your intelligence or education. What I am questioning is ... why does it matter whether or not you know a patient's HIV status? I am not advocating sharing this information with all caregivers or not sharing it ... just questioning its relevance in the context that's being debated here which is whether or not phlebotomists, techs, ancilliary staff, etc. who would not otherwise know a patient's diagnoses need to be particularly informed about this one diagnosis.
If you believe that all caregivers need to know this one particular diagnosis -- can you explain why?
What everyone needs to know are the proper precautions to use with a patient. Certain patients need to be cared for using certain extra precautions such as droplet, contact, reverse isolation, etc. But HIV, HBV, HCV and other blood-borne pathogense are spread only through transmission of bodily fluids. Universal precautions are sufficient protection.
I think everyone here knows how HIV is transmitted. Even your link to the CDC states that healthcare workers are at risk. I would consider drawing blood a risk. Yes, we all know about Universal precautions but I think some people here would appreciate a heads-up going into a situation where they were drawing blood on an HIV+ patient, whereas some people see this as a violation of the patient's rights. Many of you state this is the law. If it is, so be it. I just personally don't understand how some diagnoses are able to be disclosed and others are not. Everyone here just has their own opinion.
I'm stunned that you would clean up a patient without gloves, and frankly, hope that you are not caring for my family member. Gloves provide 2-way protection between patient & caregiver.
she did say she had been a CNA "for many years". i went to nursing school in the early 80's, we didnt use gloves for much of anything....certainly not to change a bed, not even to start iv's
she did say she had been a CNA "for many years". i went to nursing school in the early 80's, we didnt use gloves for much of anything....certainly not to change a bed, not even to start iv's
Gloves and universal precautions were not always used, but have been standard practice for many years. This is not new.
The poster I referenced gave an example of an empty glove box as a "reason" to clean a patient without gloves. Unacceptable, IMO.
And why is is so bad to admit I know someone who's views I don't share? Still wondering about that one...... No one I know agrees with me about everything, but they still admit they know me. I would not advocate the island scenario, and in my defense, I did ask the person who has this view, "If I got HIV at work from a needle, would you want to ferry ME out to the island?"
Considering this was a friend, I think their view may be a bit different now. It's all in how you look at it.
FWIW I agree with your sentiment that we have a right to know so this is kind of OT but long ago I decided that I would not be friends with anyone who was hateful or didn't respect animals. Just a judgement call on my part I guess but something to consider. I agree to disagree all the time but this "friend" sounds reprehensible to me.
I think everyone here knows how HIV is transmitted. Even your link to the CDC states that healthcare workers are at risk. I would consider drawing blood a risk.
Yes, drawing blood is a risk. Healthcare workers are at increased risk for HIV & other blood-borne illnesses because they perform invasive procedures that have the potential for exposure to bodily fluids. Workers in other occupations don't perform such tasks that increase their risk.
Yes, we all know about Universal precautions but I think some people here would appreciate a heads-up going into a situation where they were drawing blood on an HIV+ patient.
This is what I am questioning: what is it that you do differently with a known HIV+ patient that you don't do with patients whom you *believe* to be free of these blood-borne pathogens?
Universal precautions are (or should be) just that -- UNIVERSAL -- to minimize the risk of accidental exposure to both healthcare workers and patients.
I would not do anything differently with an HIV+ patient versus other patients. I guess my feelings on this come from me working in the OR for five years as a surgery scheduler some years back. This was a very large hospital with 20 ORs. We scheduled every procedure you can think of and occasionally would have an HIV+ patient for surgery. We were instructed by all of the higher ups... each specialty nurse clinician, to put a special code on these cases when scheduling to alert the surgical staff to take "extra" precaution. They had to get space suits, extra scrub techs, etc. Yes, I am sure there were undiagnosed HIV cases that did not receive these extra measures and that is just a statistical risk. But if you know or a fact someone is positive, I believe those surgeons, nurses, techs, have the right to take on extra protection. Its just practical to me. There was an anesthesiologist who many years back in surgery was infected with an HIV positive patient. He ended up passing away. My thoughts.
I would not do anything differently with an HIV+ patient versus other patients. I guess my feelings on this come from me working in the OR for five years as a surgery scheduler some years back. This was a very large hospital with 20 ORs. We scheduled every procedure you can think of and occasionally would have an HIV+ patient for surgery. We were instructed by all of the higher ups... each specialty nurse clinician, to put a special code on these cases when scheduling to alert the surgical staff to take "extra" precaution. They had to get space suits, extra scrub techs, etc. Yes, I am sure there were undiagnosed HIV cases that did not receive these extra measures and that is just a statistical risk. But if you know or a fact someone is positive, I believe those surgeons, nurses, techs, have the right to take on extra protection. Its just practical to me. There was an anesthesiologist who many years back in surgery was infected with an HIV positive patient. He ended up passing away. My thoughts.
Your example seems like a perfect reason you would want to know about HIV status - invasive, surgical procedures. I don't have an issue with that at all. It's a given that invasive surgical procedures are going to create a much greater risk and I would imagine there are increased precautions that could be undertaken to minimize exposure, but even then I would hope that OR personnel are taking every precaution they can.
The point of my original post is that as a phlebotomist, I think the patient's right to confidentiality trumped MY right to know about their condition. I'm going to take the same precaution with each and every patient regardless of HIV status, so that information about them should have remained confidential.
i guess i'm not understanding how our knowing about hiv status, is going to change the way we approach our iv's, blood draws?
universal precautions are just that.
i personally have no need to know if someone is hiv +.
if there's a needlestick, i follow protocol.
i'm just trying to figure out the logistics of why we need to know.
leslie
You don't need to know and neither do I however I would prefer to know simply because I would try to focus a bit more on my safety. I know we don't know who may have it and isn't diagnosed etc. but if we do I would prefer to know, thats all.
To me its no different than being more focused when I am transferring a frail elderly person. I am more careful than with someone young in better physical shape. Not that I'm man-handling or throwing anyone around in the bed, just that I am more careful with someone I know is frail. So to me its not about universal precautions its about my focus which I know should always be 100% but if anyone here wants to say their focus is always 100% I'm gonna spit tea across my keyboard.
This just happend recently. Really no point to the story but it fits the thread.
I had an HIV + pt, the pt needed an NG tube. I am still on my first year of nursing, so I had a more experienced nurse join me as I have only done a few NG tubes. I did not tell the other nurse the pt was HIV + as I didnt feel it was necessary and truthfully I did not even think to tell her as I don't treat HIV+ patients any differently then my other patients.
We stuck an NG tube down this patient, and in the process of grabbing a sample for GOC, gastric juices started pouring out. We were both wearing gloves, and the pt even said quitely "With all the blood and fluids coming out I wanted to let you know I am HIV + and please be careful".
Now there is really no point to this story now that I reread it other then the patient took it upon to give us a heads up. I already knew as it was my pt, the other nurse did not.
The other nurse just stated we take universal precautions to protect both the pt and ourselves.
(I use it in replace of he/she even in stories Its not meant as an insult to the pt, more privacy related just in case).
Its not meant as an insult to the pt, more privacy related just in case).
Altra, BSN, RN
6,255 Posts
Angelfire, I am not questioning your intelligence or education. What I am questioning is ... why does it matter whether or not you know a patient's HIV status? I am not advocating sharing this information with all caregivers or not sharing it ... just questioning its relevance in the context that's being debated here which is whether or not phlebotomists, techs, ancilliary staff, etc. who would not otherwise know a patient's diagnoses need to be particularly informed about this one diagnosis.
If you believe that all caregivers need to know this one particular diagnosis -- can you explain why?
What everyone needs to know are the proper precautions to use with a patient. Certain patients need to be cared for using certain extra precautions such as droplet, contact, reverse isolation, etc. But HIV, HBV, HCV and other blood-borne pathogense are spread only through transmission of bodily fluids. Universal precautions are sufficient protection.