Abuse Screening in the Ambulatory Mobility Clinic Josephine Rockman RN, BScN, Mari Vella MSW, RSW, Ines De Campos RN, MSc St. Michael’s Hospital
PROCESS (con’t)
FOCUS
PURPOSE & OBJECTIVES
To implement a standardized process of abuse screening in the Fracture Clinic of St. Michael’s Hospital
• To develop a screening tool to be given to every patient at every visit, responsive to the needs of patients, capturing any safety concern
This BPG initiative was informed by the following recommendations from the Registered Nurses’ Association of Ontario (RNAO) Best Practice Guideline (BPG) Women Abuse Screening, Identification & Initial Response: 1.0 Nurses implement routine universal screening for woman abuse 2.0 Routine universal screening be implemented for all females 12 years of age and older 3.0 Nurses develop skills to foster an environment that facilitates disclosure 4.0 Nurses develop screening strategies and initial responses that respond to the needs of all 5.0 Nurses use reflective practice to examine how their own beliefs, values, and experiences influence the practice of screening. 6.0 Nurses know what to document when screening for and responding to abuse 7.0 Nurses know their legal obligations when a disclosure of abuse is made 8.0 Mandatory educational programs in the workplace be designed to: increase nurses’ knowledge and skills; and foster awareness and sensitivity about woman abuse.
BACKGROUND • The objective of the St. Michael’s Hospital 2011 Quality Initiative program was to raise awareness of abuse and impact of violence on our Ambulatory Orthopedic patients • Statistics revealed 25% of St. Michael’s Hospital Fracture Clinic patients suffered abuse at home (Bhandari et al., 2011) • No formal process in place in the Fracture Clinic to assess patient safety at home in regards to an abusive setting • A formal screening process was developed and implemented in 2010 in St. Michael’s Hospital Emergency Department as part of the implementation of RNAO BPG Women Abuse Screening, Identification & Initial Response
RECOMMENDATIONS/NEXT STEPS • Starting in Spring 2016, every patient will receive the screening assessment during their Fracture Clinic appointment • Continue to provide education and resources for staff to create an environment that facilitates disclosure and supportive care
• Increase awareness and knowledge of Abuse Screening Pathway, including the legal obligation when a disclosure of abuse is made
• Capture abuse screening completion rates and # of referrals of an identified case through random audits
• Creating a safe environment where patients feel comfortable to disclose their experience
• Report metrics back to staff using the Outpatient Mobility Care Utilizing Evidence (CUE) Dashboard
• To ensure all staff are aware of hospital and community resources to support patients disclose abuse
• Abuse screening pathway to be re-evaluated by the Fracture Clinic team on a quarterly basis
• Ensure a TOA from the Emergency Department to the Fracture Clinic for patient’s who are screened ‘yes’ for abuse
REFERENCES
PROCESS •
Sprague S, Goslings JC, Petrisor BA, Avram V, Ayeni OA, Schemitsch EH, Poolman RW, Madden K, Godin K, Dosanjh S, Bhandari M, (2013).Patient Opinions of Screening for Intimate Partner Violence in a Fracture Clinic Setting Journal Bone Joint Surgery American 95:13
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O’Campo, P, Kirst, M, Tsamis, C, Chambers, C, & Ahmad, F. (2011). Implementing successful intimate partner violence screening programs in health care settings: evidence from a realist-informed systematic review. Social Science and Medicine, 72(6), 855-866.
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Registered Nurses’ Association of Ontario (RNAO). (2005). (Revised 2012). Woman Abuse: Identification, screening and Initial response. Toronto, Canada: Registered Nurses’ Association of Ontario.
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Bhandari M, Sprague S, Dosanjh S, Petrisor B, Resendes S, Madden K, Schemitsch EH, PRAISE Investigators. (2011). The prevalence of intimate partner violence across orthopaedic fracture clinics in Ontario. J Bone Joint Surg Am. 93: 132-141.
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College of Nurses of Ontario, (2016) Abuse Prevention: One is too many Retrieved from http://www.cno.org/en/learn-about-standardsguidelines/educational-tools/abuse-prevention/
Staff questionnaire to assess knowledge base & comfort level
In-service for staff based on needs identified ST. MICHAEL’S HOSPITAL IS CONCERNED ABOUT
Staff educated on abuse screening pathway for Outpatient Mobility Program
Develop abuse screening tool
Posters displayed in patient and staff areas Additional resources provided to staff to support a positive patient disclosure Social Work liaison between Ambulatory Program and Emergency
YOUR SAFETY IN THE HOSPITAL AND AT HOME
Figure 2. Abuse Screening Pathway – Mobility Program
Please answer the following questions: YES
NO
Do you feel safe at home?
Is your visit today a result of an unsafe home setting?
Would you like to speak to a healthcare professional about this issue today in a private room?
NEED HELP MAKING A SAFETY PLAN? Call the Assaulted Women’s Helpline: 1-866-863-0511 or 416-863-0511 Or Victim Services Toronto 416-808-7066 To get more information on how to make a safety plan
Figure 1. Abuse Screening Tool
LESSONS LEARNED • Role playing is a helpful technique to increase staff comfort level with engaging patients in conversations about their safety at home • Staff’s personal experiences with abuse may impact their ability and comfort level to screen patients for abuse and they may require additional coaching and support • Creating a safe and supportive environment for staff to ask questions and voice concerns is critical to uptake • Approaching staff in one on one sessions provided the opportunity to discuss concerns and reduce stress associated with the adoption of the new screening process • Seek opportunities to align resources with other department quality and research initiatives
ACKNOWLEDGEMENTS • • • • • • • • •
Esther Carter RN Christopher Streit R.T. (Ortho) Katherine Skrabec R.T. (Ortho) Niko DaSilva, Jo-Anne Harris, Nichola McLean Caroline Jones BSc MScPT Angelo Papachristos BScPT MBA, Rachel Yantzi RN BSN, MN Patricia O’Campo PHD Nursing Professional Practice at St. Michael’s Hospital