R.N.s report private information to abusive family members

[Alnitak7]

In a true-to-life case scenario, an abusive relative calls the hospital and asks for information about a helpless patient who they have committed crimes against. Why does every nursing staff not have any plan to avoid this?

If a patient has been the victim of a felony and it was an immediate relative who committed crimes against them then why should nurses ever by permitted by law to share private information with them? I am a witness to them doing this.

Sharing private information with relatives who are physically and mentally abusive should never have been legally permitted even prior to H.I.P.A.A. or at any time in history and yet some nurses only care about what is legal for them.

If a patient is in a hospital and they do not want their relative who abuses them to know they are even in there and this relative is also known to gossip with every neighbor in town, the staff can still share their private information, "because they are an immediate relative."

I would assume that H.I.P.A.A. might have helped to change some of this but it should never have been legal.

"Is there any family member you do not want us to share information with?" Why hasn't every single nurse been required to find out about this from their patients?

[Sun0408, ASN, RN]

So many issues going on in the above, I'm not sure where to begin..

I can tell you from my unit ICU a password is set up in person on admission and only those with the password get any information over the phone. All other calls are directed to call the family. If my pt is AAOx3, I direct calls to them.

[Rose_Queen, BSN, MSN, RN]

Our patients have to sign a consent giving permission to speak with people they designate. Anyone else is not given any information. In the case of a patient admitted as a trauma, they are automatically a confidential patient. If they are unable to designate contact info, no one gets info. Sounds like your facility has some issues to work out.

[NurseLatteDNP, MSN, DNP, RN]

We are not even allowed a password because of an incidence that happened a while back. A 'no-info' patient means that we don't even know about that patient when someone calls. If we say "what's the password", it indicates that we have that patient, but just can't give out any info. And we are not allowed to even give that much away.

[applewhitern, BSN, RN]

Years ago, before we had all these privacy laws, I was taught not to disclose any information on the phone about a trauma patient because it could be the media, pretending to be a family member. Our surgeons would hang our phone up if they heard us talking on the phone about a patient! Now, today, would you believe my facility asked us to use part of the patient's social security number as the password? I won't do this; someone's social, even part of it, is nobody's business.

[applewhitern, BSN, RN]

Every hospital I have ever worked at has required the patient to state whether or not they want their information shared with anyone. We have a code we put right by their name, that tells us this patient is strictly private. We generally do not tell anybody anything over the phone; we ask them to come in, if we need to discuss their plan of care. Otherwise, the patient must give us permission. If we cannot obtain permission, then we don't discuss anything with anyone. If you are a nurse, you cannot "police" a trauma/felony situation. You should simply refer it to social services, case mgt., police, etc.

[Meriwhen, ASN, BSN, MSN, RN]

In psych we do things a little differently--we're far more sensitive to patient privacy. When patients register in the psych hospital, they have two forms to complete. The first is the HIPAA form. The second is a form that tells us who can know they are in the hospital and are willing to receive calls/visits from. This second form only allows us to put the caller/visitor in contact with the patient--no patient info is discussed.

If someone isn't listed on either form, it doesn't matter who they are and how they are related to the patient: no patient info is given and we will not confirm anyone's presence. I have had to say "Sorry, but..." to parents, children and spouses because the patient refused/was not able to complete these forms. This has caused me to be to bear the brunt of a lot of rage from angry callers...but that's my job. I don't care if it's the patient's 85-year old mother calling from Siberia on her last dime--if the patient hasn't authorized me to talk to her about the patient's care or even let Mom know that they're a patient, I won't say a word about it.

Now, if the PATIENT themselves tells someone they're there and why, and that person tells the entire world...or the patient called someone and gave them the phone number of the patients' phones, then there's zero we can do about that. The patient chose to reveal that info. We will never release PHI, but we can't control what the patient themselves says to others.

[jadelpn, LPN, EMT-B]

Under no circumstances does a nurse EVER share ANY information with any family member, friend, private caregiver, etc. etc etc. abusive or not. IF a patient is deemed incompetent (and that is a whole nuther issue) then they have a guardian, or a health care proxy....which gets into a different issue. But if what you are speaking about is an A&O person/patient NEVER give any information over the phone, NEVER give information in person. Privacy is huge, and there is a form that asks "If someone calls or comes and asks for you by name, is it ok to tell them you are a patient here?" They say yes or no. If they say no, then in my practice, I am stringent on "I can neither confirm nor deny that that person is a patient here". We also do not get into "it is ok for x but not y and maybe z some information but not all" The patient can do what they would like, but it should not come from you.If it is a family member, visitor, etc. and the PATIENT chooses to share, have at it then. Otherwise, I would not breach my patient's trust to privacy issues.

Most people mean well, however, it doesn't matter how well meaning. If what you are describing is an abusive situation, get social services involved, you have a duty to report, and the patient has a right to safety. It is really important in these situations to NOT confirm nor deny a thing, as then it can open the patient up to many, many things.

If a patient gives an OK for people to know they are patients, I generally have a "I have strict privacy guidelines that I have to adhere to" explination, and it is all that is needed. Yes, you will have angry family members, but to lose your job (or your license) because you gave so and so the low down on patient xyz, it is far better to give the above a try, or defer to your charge nurse to do so. "I am sorry, but I am unable to share that information with you. Let me get my charge nurse to explain it more throughly".

Otherwise, you do have a duty to act. Get some assistance from other disciplines to do so.

[MunoRN, RN]

If by "helpless patient" you mean unconscious then yes, information is shared with the next of kin which is often the spouse. We're actually required to share all pertinent information for medical decision making in that situation. Hospitals don't typically have access to, or routinely investigate the criminal histories of family members. If there were information available to suggest that the spouse should not be next of kin then steps can be taken move to an alternate next of kin.

[Alnitak7]

Years ago, before we had all these privacy laws, I was taught not to disclose any information on the phone about a trauma patient because it could be the media, pretending to be a family member. Our surgeons would hang our phone up if they heard us talking on the phone about a patient! Now, today, would you believe my facility asked us to use part of the patient's social security number as the password? I won't do this; someone's social, even part of it, is nobody's business.

This is shocking because anyone who snoops in a patient's business or goes rooting through their belongings might know their social security number. Also, parents are the first people to have access to this even if they have committed felonies against them and are a threat to their welfare,

[Alnitak7]

If by "helpless patient" you mean unconscious then yes, information is shared with the next of kin which is often the spouse. We're actually required to share all pertinent information for medical decision making in that situation. Hospitals don't typically have access to, or routinely investigate the criminal histories of family members. If there were information available to suggest that the spouse should not be next of kin then steps can be taken move to an alternate next of kin.

A helpless patient could be someone with a mental breakdown, early dementia or who can't walk. I was referring to any and all possible definitions. If they even tell the staff once that a relative is not to be trusted, this should not be treated lightly.

[jadelpn, LPN, EMT-B]

This is shocking because anyone who snoops in a patient's business or goes rooting through their belongings might know their social security number. Also, parents are the first people to have access to this even if they have committed felonies against them and are a threat to their welfare,

With all due respect, we don't know if anything is necessarily true or not. When one is speaking of committing felonies, and threats to patient's welfare, then you need to get other disciplines involved. Including law enforcement if appropriate. Anyone who is truly a threat to a patient's welfare, they have no business being in the room with the patient to root and snoop.

Accusing someone of these crimes is serious business. So be sure that you have assessed, concluded, followed policy, and have your charge or even manager well apprised. The MD well apprised. Just be sure that ALL of your "T's" are crossed, and your "I's" dotted, to protect you as well as the patient.