Is your patient hiding something from you?
Omissions can be life-threatening
The middle-aged man on medication for erectile dysfunction who is given beta-blockers for chest pain. The diabetic patient on glucophage who gets a CT scan with contrast. The toxic ingestion patient who refuses to tell you what drug was taken and when. These are all examples of "nondisclosures" that could harm your patient.
"Ultimately, we are only as good as the information given to us by patients, pre-hospital caregivers, or family members," says J. Miller Morrow, RN, BSN, CEN, ED nurse at St. Luke's Baptist Hospital in San Antonio.
Watch for these signs that a patient isn't being truthful, says Imelda Prado, RN, clinical care coordinator for the ED at Swedish Covenant Hospital in Chicago: He or she is unable to look at you, gives varying stories, friends and family give you conflicting information, or the patient doesn't give you clear details of the illness or complaints. Other warning signs include lack of direct eye contact or looking over to family members or friends before answering questions posed to them, says Morrow. Try these techniques:
• Ask specifically about psychiatric medications.
Patients may be afraid if they admit taking medications used for treatment of behavioral disorders or a psychiatric history that they will be looked down on by staff, says Freda Lyon, RN, BSN, MHA, service line administrator at Bixler Emergency Center in Tallahassee. "Patients are often embarrassed," she says. "The emergency nurse has to be perceived as nonjudgmental."
When asking questions about mental health history and medication history, be sure to explain the importance of mediation interactions, says Lyon. "Ask the patient if they have a list of the medications they are on from their last physician or hospital visit," she suggests. "When all else fails, look at the patient's visit list."
• Ask open-ended questions.
Prado recommends asking things such as, "How can I be of help?"
"Encourage the patients to tell their own story in their own words and talk about whatever is important to them," she says.
• Refer to the patient's previous medical records.
"If these are available, this can be an invaluable tool," says Morrow. Say, "I see you were taking _______ last time you were here. Are you still on that?"
• Remind the patient that their responses and their entire medical record are protected under federal patient privacy law.
• Talk to the patient privately.
Ina Helton, RN, unit expert for the ED at UAB Hospital in Birmingham, AL, says, "At any time, you can ask a visitor or a family member to step out of the room."