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Aetcom Module - 2

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291 views3 pages

Aetcom Module - 2

Uploaded by

Aishwarya Nayaka
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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AETCOM MODULE -2

18. Laboratory diagnosis of HIV infection


EXERCISE 18.2: CONFIDENTIALITY PERTAINING TO
PATIENT'S IDENTITY IN LAB RESULT
Competency
 MI 8.14: DEMONSTRATE CONFIDENTIALITY PERTAINING TO
PATIENT IDENTITY IN LABORATORY RESULTS
Specific learning objectives
At the end of the module students should be able to
 Describe confidentiality of patient identity in relation with laboratory investigations.
 Identify the routine events in testing and reporting of clinical samples where the
confidentiality of patient identity is applicable.
 Identify the ways to rectify breach in confidentiality in patient identity in relation with
laboratory investigations.
 Discuss and apply with justification situations/reasons where breach in confidentiality is
acceptable.
 Describe and demonstrate application of ethical principles and medico legal issues with
respect to confidentiality of patient identity in laboratory results.

In a given situation/case scenario, identify the events that show disrespect / breach in
confidentiality to the clinical sample/ data and suggest ways to rectify them.
1. SAMPLE CASE SCENARIOS
 A LITERATE HIV PATIENT GETTING EMBARRASSED WHEN SHE
FINDS THE TEST RESULT MENTIONED ON HER CASE FILE.
 Apologize for breach in confidentiality of the clinical/ laboratory data (ethical
principle involved) confidentiality.
 The test result mentioned on the case file must be erased as confidential
information must not be kept in open (data protection measures-obligation of the
hospital to protect patient information from disclosure).
 Post- test counselling to be given to the patient. Remove the report from the file if
it has been included. Handover the report directly to the patient in a closed
envelope.
 Corrective actions to be taken:
 Colour codes or labels should be pasted to HIV seropositive case files.
 An HIV policy must be prepared & implemented in the hospital to reduce such
incidents, the persons responsible for the present incident should be instructed
about maintaining confidentiality.

2. SAMPLE CASE SCENARIOS


 PRE-SURGICAL HIV TEST REQUEST RECEIVED WITHOUT PRE-TEST
COUNSELLING FROM SURGERY WARD.
 Lack of application of medico-legal practices.
 HIV testing should not be undertaken without written informed explicit consent
because of the issues of confidentiality discrimination, victimization and
psychological harm.
 Pretest counselling helps in assessment of risk and risk management.
 Testing should always be accompanied with counselling, consent should always
be real, informed, explicit and in writing.
 Corrective actions to be taken:
 Inform the concerned doctor, staff nurse of the ward about the breach that has
happened. Ask them to do pre-test counselling and send the form mandatorily.
 Accept the test sample and perform the test. Critical alert to be given to doctor, if
test is HIV reactive. Release the report only after receiving the pre-test
counselling form.
 Educate the patient in their local language. Forms also being in local language in
addition to English would also help.

3. SAMPLE CASE SCENARIOS


 YOU ARE TREATING A COVID-19 POSITIVE PATIENT AND HE DOES
NOT WANT YOU TO REVEAL HIS DIAGNOSIS TO OTHERS.
 Counsel the patient and try to convince him to disclose the information to people
at risk and also follow covid appropriate attire.
 If he is not still convinced by using the right of privileged communication, inform
the potentially affected /authority directly as appropriate.
 Maintain confidentiality by identifying the patient with alphanumeric code
instead of the name.
 Release the details to the government authorities with this code only.
 Patient can upload his/her details on Arogya Setu App.

4. SAMPLE CASE SCENARIOS


 A NURSE HAS NEEDLE STICK INJURY WHILE PERFORMING
PHLEBOTOMY. THE PATIENT’S HIV AND HBV STATUS IS UNKNOWN.
THE PATIENT IS REFUSING TO GET TESTED FOR HIV.
 The duty to respect patient autonomy is central in the practice of medicine, but it
is not absolute.
 Unconsented HIV testing in cases of occupational exposure can be justified on
the balance of harms and benefits to both source and exposed persons.
 Unconsented HIV testing is permitted in cases of occupational exposure. if source
patients are unable to consent for testing because they are absent, deceased,
comatose or lack capacity to consent. if there is a probability of others been at
harm (in this case, the nurse).
 He should be counselled, not only about the nature of the disease, its risks, but
also the benefits to the nurse (alleviation of the apprehension & stress, foregoing
unnecessary PEP etc) by consenting to do the testing.
 The source patient must be made aware of the possibility of unconsented testing
in certain circumstances If the patient still refuses testing.
 A) if blood sample is available, then it is the right of the exposed person
that the sample is taken for testing.
 B) if blood sample is not available, it is the right of the exposed person to
ask for fresh sample for testing.
Mandatory measures:
 When unconsented testing is done, all standard measures to ensure strict
confidentiality should be employed with applicable law.

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