Transcript UPMC Nurses Powerpoint presentation

The Role of the Sexual Assault
Nurse Examiner
in the Investigation of Reported
Sexual Assaults
Factors Affecting Delay of
Care/Reporting
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Ingestion of
drugs/alcohol
Amnesia
Doubt
Self Blame
Afraid parents will
find out
After disclosure to
family/friend
Sexual Assault Nurse Examiners
(SANE)
Sexual Assault Nurse Examiners
(SANE)
Forensic Nurses play an integral role in
bridging the gap between law and
medicine. They should be in each and
every emergency room”
Joseph Biden, Vice President, United States
from Forensic Nursing: a Handbook for Practice
We Can’t Do This Alone
Collaborate with Health Care
Team
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Medical Screening Exam
 Physician performs
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Notification of Advocate/Law Enforcement
 Who can do this?
 When does it get done?
Advocates
Hospital personnel will initiate the call to
Pittsburgh Action Against Rape (PAAR) or
the Center for Victims (CV) upon patient
arrival
 They offers emotional support and
accurate factual information to victims of
sexual assault both during the initial crisis
and for as long after as the victim wishes
 Insures victims are treated with dignity
 Communication with advocate is privileged
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The Law
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We will call law enforcement in the
jurisdiction in which the incident
occurred.
 Reporting does not obligate or
penalize the victim who may later not
want to press charges.
 Acute and past incidents are
reportable.
 Statute of limitations (adult S.A.) is 7
years.
In the Emergency Department
In the Emergency Department
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Life threatening
emergencies are
always the priority
PCCD FRE Claim Form
“Am I OK?”
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The medical forensic exam is health care focused and
patient centered
Address immediate concerns
Avoid revictimization
Assess for safety including after discharge
Provide reassurance
Identify emergent conditions
Relieve physical pain
Identify injuries
Collect evidence
Provide prophylaxis for STIs
Provide pregnancy prophylaxis
Have a follow up plan
Safety
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Where is the assailant?
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Is this also Domestic Violence?
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Is the patient suicidal?
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Who is actually in the room with the patient?
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Where will the patient go when the exam is
completed?
Informed Consent
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Risks
Benefits
Alternatives
Consequence if
treatment or
procedure is not
performed
Crime Victim Consideration
Patient who has been a crime victim is experiencing:
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Loss of control
Invasion of body
It is best to allow the patient to consent to each item of
collection to regain that control
Assumed Consent
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In a medical emergency, consent is assumed for
medical intervention
Forensic consent goes beyond medical consent
and should be obtained when possible
Facility policy & procedure as well as legal counsel
will determine appropriate course of action on
case by case basis
Patient Says “Maybe”
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In accordance with the Violence Against Women
Act (2013), Patients may have evidence collected
and not report the crime- UPMC policy is to hold
the kit for 365 days
Patients may also request exam and medical
treatment (including prophylaxis) with no evidence
collection
Patients may have a portion of the exam and
decline other portions
“Waiting it Out”
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If a patient appears intoxicated, consider blood
alcohol level
 Not usually completed in ED unless SA is a
possibility.
While it may delay care, it ensures that our patient
is sober enough to consent to the forensic exam
and/or release of evidence
It is also a more concrete way of assessing
sobriety, as opposed to opinion
Patient Says “No”
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If a patient presents and declines to have evidence collected,
we should not collect*
Hospital should still perform MSE to comply with EMTALA
and ensure that patient has capacity for consent/ refusal
EC and prophylaxis and advocacy should still be offered
If a patient changes his/her mind during evidence collection,
STOP
Allow the patient time with the advocate to decide what they
want to do
What we askInterviewing
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Date and time of sexual assault
Pertinent Patient Medical History
Recent Consensual Sexual Activity
Post-assault Activities of Patents
Assault-related Patient History
Suspect Information
Nature of the Physical Assault
Narrative of Assault
Description of the Sexual Acts
Strangulation assessment
First 8 pages of documentation
Forensic Photography
Documentation
Forensic Photography
Documentation
Injury description and
documentation
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Forensic documentation should include:
 L=location
 A=appearance
 S=shape
 T=type
 S=size
Loca
tor #
Type
Ph
oto
#
1
CT
4-6
2
AB
7-9
Description
3mm x4mm
oval area,
purple and red
2cm red linear
area with dried
blood
Alternate Light Source
Examination
Evidence Collection
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Clothing
Oral Swabs and Smears
Buccal Swabs
Fingernail Evidence
Dried Secretions
Genital evidence
Miscellaneous Evidence
Drying and Packaging the
Evidence
Minimum Drying time 1 hour on all
swabs
 Clothing may take longer
 Specific documentation on all items
 Packaging the kit and clothing
separately
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What Happens Now?
After the Exam
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Medications
nPEP
Education
Follow Up
Shower/fresh
Clothing
Safe Place to Stay
Transportation
Testifying in Court
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Educated on
testimony
Beneficial to victim
Patient Education Video
Questions?