Transcript TTWP Forensics

When to call the Forensic Nurse
Examiner
Betsy Vick, RN, FNE, CEN
Background on the Forensic Program
• The Forensic Nurse Program started at St. Mary’s
Hospital in 1993
• There is 24/7 coverage
• Forensic NurseExaminers (FNE) provide highly
specialized care to patients of all ages, from infants to
the elderly, as well as the deceased where abuse
and/or neglect is reported or suspected. Patients may
include victims of sexual assault, child abuse, family
violence, elder abuse, physical assault and workplace
violence.
What is a forensic exam and how does
it get started?
• Exams begins with a medical evaluation by a provider
in the emergency department (ED) to ensure all
emergent medical needs are addressed.
• The forensic nurse is notified and responds to the ED.
• If indicated an advocate is paged and responds as well
to the ED to see the patient and will stay with the
patient throughout her exam
• Forensic nurse discusses with patient the options of
reporting the assault to law enforcement or having
anonymous evidence collection.
When to call Forensics
• Any time a healthcare provider contacts CPS
or APS they should start thinking about calling
forensics.
• If a child discloses physical or sexual abuse
• If there are suspicious injuries
• If you have a “feeling” you can always call, it is
never wrong to call. Forensic nurses can help
you talk through situations.
Types of Suspicious Injuries
• Any injury that is not consistent with the story
• Patterned injuries. For example skin
discoloration that could be consistent with
finger marks, or a belt strap.
• Unreported injuries discovered on x-ray
After a consult with a forensic nurse
what happens?
• After a call is made to the forensic team, the patient may warrant a
transfer to the emergency department, because that is how the
patient’s are registered and seen.
• If the patient is out of the window for evidence collection (Sexual
assault 120 hours and strangulation as long as no one has touched
their neck with an ungloved hand and they have not showered,
evidence can be collected) an appointment can be made to be seen
at a convenient time for the patient and family.
• If it is an acute injury/assault CPS must be called and law
enforcement can be notified and the patient would be seen
through the emergency department.
• The patient may not have to be seen, it is always best to call and
talk it out with the FNE.
The Forensic Exam
• Regardless of the type of assault any patient over 4
years old (that is able to communicate effectively) is
seen and a history is obtained from the patient
(without leading the patient). The FNE’s are specially
trained on techniques to speak with children
• All patients get a thorough physical exam, including
photographic evidence of all injuries including
measurements of the injuries.
• The bill goes to the a victims fund, if the patient can
not pay the remainder of the bill, the hospital absorbs
the bill. A victim will never have to pay for treatment
associated with an assault.
Forensic Exam Continued
• After the examination, the FNE advises the MD
on any testing that may be recommended based
on injuries or history.
• STD testing is completed and prophylaxis
medication is given for all sexual assault patients.
• HIV testing and prophylaxis medications is
offered to all sexual assault patient’s. A voucher is
also provided to cover the cost of the 28 day
regimen.
Conclusion
• The FNE will complete the patient’s chart and
have it reviewed with in 7 days. A copy will be
sent to CPS, and law enforcement is
authorized.
• The FNE is often contacted by The
Commonwealth Attorney's office to testify as
to their findings.
Final Thought
• ALWAYS ALWAYS
ALWAYS...trust your gut
instinct!!! Make the call—it is
never wrong to call—you could
be the one to stop the
violence for your patient!!