Patient Privacy Question

[ffemt8978]

Had an interesting point brought up in class earlier today.

Part 1:
Let's say your patient tells you they have AIDS/HIV/HCV but your partner is out of earshot at the moment.

Question #1: What do you do?
A. Say nothing to your partner
B. Ask the patient if they can repeat what they told you
C. Ask the patient if you can repeat what they told you
D. Tell your partner
E. Remind your partner to use "FULL" BSI.

Part 2:
The same patient then tells you that they do not want the information repeated or revealed to anyone else.

Question #2: How do you document what they told you on your incident report?
A. Do not document it at all
B. Do not document it, but annotate on the incident report that the patient has additional medical history they do not wish to be revealed
C. Document it as part of the patient history.

Part 3:
The same patient tells you that they are taking a disease specific drug like AZT, but they don't want anyone to know about it.

Question #3: Do you document the medication?
A. Yes
B. No

Okay, now that you've answered these three simple ( :blink: ) questions, why did you do what you did?

 

[TKO]

hmmmm...For question one I would definitly tell my partner to use full BSI precautions ....I may also flat out tell my partner about the disease of course making sure the pt did not hear this conversation.

Question 2: I think I would document on the PCR addition medical information but at the recieving facility I would inform them of the disease.

Question 3: I would document the medication.

The reasons for these answers are simple... I am looking out for fellow co-workers. Why would this pt tell me and not tell my partner.. I think I have a duty to inform other health care providers of a potential hazard. Not telling would put my partner and everyone else at a major risk..maybe this pt has not so good intentions.

 

[Chimpie]

What TKO said.

Chimp

 

[ffemt8978]

I'm not saying I would do it differently, but I thought it was a breach of confidentiality to disclose patient diseases like that without their permission. I don't know what the laws are in Canada, but I'm pretty sure this is against the law in the US. I was told in my EMT class that the use of code words like, "Use FULL BSI" is against the law, and could cost you your license and more.

 

[MMiz]

Let's say your patient tells you they have AIDS/HIV/HCV but your partner is out of earshot at the moment.

I tell my partner. Because we are both medical licensed medical professionals providing care to the patient, anything the patient tells me, I tell my partner.

The same patient then tells you that they do not want the information repeated or revealed to anyone else.

So I tell my partner quietly without the patient knowing.

The same patient then tells you that they do not want the information repeated or revealed to anyone else.

I'd write,
Pt states "I have aids"

Part 3:
The same patient tells you that they are taking a disease specific drug like AZT, but they don't want anyone to know about it.

Question #3: Do you document the medication?

Absolutely.

This isn't about me being a nice or mean EMT, but it is my job to document medications not just for legal purposes, but for the medical professionals that will need that information later. It's not about being politically correct, but about providing the best care for the patient.

HIPAA doesn't stop EMS professionals for documenting such information on run sheets. I wouldn't say it over the radio or just blurt it out. I'd pull the doctor aside and share what I know about the patient.

Good questions though, I'd like to see how others respond.

 

[ffemt8978]

Originally posted by MMiz@Jun 21 2004, 11:24 PM
Good questions though, I'd like to see how others respond.

Kind of why I'm waiting to post how I would handle it. I'm also hoping to have the classroom answer tomorrow, so I can include it.

 

[sunshine1026]

Question 1: Yes, I would tell my partner.

My partner is also a health care provider for this patient, so it is not a breach of confidentiality for me to inform him/her. I wouldn't necessarily use a tone of voice that would broadcast the information to the rest of the world at large, but a simple quiet statement would do the trick.

Question 2: Yes, I would definitely document this patient's history.

It is important for the ER staff to know all of the history that we can provide, both for treatment decisions later on and for protection of those caring for the patient. The patient has chosen to accept treatment and transport, so it is not a breach of confientiality for us to document information on the run sheet.

Question 3: Yes, I would document the medication.

If I DON'T document a medication, how is the doc going to know about it and address the issues of medication interaction, etc. ?

I am curious to see what answers others have and what comes out of class.

 

[ffemt8978]

Well, the instructor still hasn't gotten back to us with the answer, so I'll go ahead and post my response.

Question #1: B - Ask the patient to repeat what they told you. (If I could do it without getting caught, I would tell my partner.)

Question #2: B - Do not document, but annotate (unless it pertained to the reason for the call, such as complications from pneumonia).

Question #3: C- ABSOLUTELY YES. The liability for drug interactions is too much, and I can always explain it as a patient care/safety issue.

 

[MMiz]

Originally posted by ffemt8978@Jun 24 2004, 01:17 AM
Well, the instructor still hasn't gotten back to us with the answer, so I'll go ahead and post my response.

Question #1: B - Ask the patient to repeat what they told you. (If I could do it without getting caught, I would tell my partner.)

Question #2: B - Do not document, but annotate (unless it pertained to the reason for the call, such as complications from pneumonia).

Question #3: C- ABSOLUTELY YES. The liability for drug interactions is too much, and I can always explain it as a patient care/safety issue.

That was great, it really got me thinking.

Today was our montly employee meeting. As we all gathered around the garage before the meeting, I asked a few guys. They all gave pretty much the same responses you did.

Thanks for bringing that to the board!

 

[rescuecpt]

Of course, this is based off of the way my agencies and my county and local protocols work...

Question #1: What do you do?
You yourself don full isolation gear, then tell your partner to do the same. If you and your partner work well together - you wouldn't even have to say anything, they would just follow suit based on your lead. THIS IS PART OF SCENE SAFETY - your PRIMARY concern - take care of the rescuer first - a dead rescuer helps no one!

Part 2:
The same patient then tells you that they do not want the information repeated or revealed to anyone else.

As far as I know, in NYS you are required to alert the hospital - there are infectious disease laws - all you have to say in your presentation is that you need an infection control team to meet you at the hospital. If I bring in a patient that I knew was infectious and I didn't request isolation/infection control, I'd have my butt nailed to the wall. THIS IS PART OF SCENE SAFETY - your PRIMARY concern - take care of the rescuer (including hospital staff) first - a suspended/revoked rescuer helps no one!

Part 3:
Question #3: Do you document the medication?

Once the patient tells me, I am required to document it. If that patient is later given a drug that interacts and I did not notify, it would come back to me - both legally and through lifelong guilt. THIS IS PART OF CYA - an incarcerated rescuer helps no one!

 

[ffemt8978]

Got an update from my instructor on this one (finally)....

No clue. It's not covered under any patient care procedures we have in place, and the state hasn't given her an answer. Our medical director basically agrees with documenting it, but doesn't want us to tell anybody. If they read it on the report, so be it.