Compliance with Screening Policies for Intimate Partner Violence

The U. S. Department of Health and Human Services (HHS) and numerous national organizations and task forces have established guidelines recommending screening for intimate partner violence (IPV).

Clinical practice and risk management experts indicate that best practice would be to include screening in emergency department protocols. Under the Affordable Care Act, these services are generally covered in new health plans without requiring a co-payment, co-insurance, or deductible.¹

In the United States, over 43.6 million women and 37.7 million men have experienced physical violence, sexual violence, stalking, or psychological aggression by an intimate partner.² About one in four women and one in ten men have experienced and reported some form of intimate partner violence.²  IPV affects all people regardless of gender, age, race, socioeconomic status, religion, or sexual orientation. Survivors of IPV can experience long-lasting effects including mental health issues, depression, and post-traumatic stress disorder (PTSD) symptoms.²

Nurses working in the emergency department (ED) can play a crucial role in the identification and management of IPV. EDs should be fully equipped and ready to identify and triage such cases since they are often the first point of contact for victims. Universal screening for IPV must be conducted consistently to increase identification and management of victims and ensure resources and referrals are provided.³

Most EDs have mandated protocols for IPV screening and intervention, but not all clinicians have received specialized training to respond to victims of various types of violence. Examination and clinical management of these patients are very complex, requiring documentation that is subject to increased scrutiny by the justice system. Clinicians, especially in the emergency room setting, must be ready for such victims while continuing to manage the rest of the department.

Screening for IPV should be conducted in a private place without visitors present. The screening questions should be asked using a respectful and nonjudgmental tone of voice.⁴ If the screening reveals any signs of abuse, the provider should be promptly notified so a secondary screening can occur, immediate safety concerns are addressed, and treatment protocols are followed. Patients should be offered the opportunity to contact law enforcement and should be given a referral to a domestic violence agency.

Victims cannot be accurately identified consistently without proper IPV screening tools. It is important for your emergency department EHR vendor to provide you with tools to improve IPV screening. MEDHOST Emergency Department Information System (EDIS) has a plug-in builder that allows for screening tools to be built per your needs, as well as charting choices that can be created to help your facility identify victims of IPV.

To learn more about how MEDHOST EDIS can help run your hospital more efficiently with customizable plug-ins and other tools, please reach out to us at inquiries@medhost.com or call 1.800.383.6278.

References

1. Coverage of Recommended Preventative Services Under 26 C.F.R. 54.9815-2713, 29 C.F.R. 2590.715-2713, and 45 C.F.R. 147.130. 80 Fed. Reg. 41317 (2015). https://www.federalregister.gov/documents/2015/07/14/2015-17076/coverage-of-certain-preventive-services-under-the-affordable-care-act
2. Smith, S.G., Zhang, X., Basile, K.C., Merrick, M.T., Wang, J., Kresnow, M., & Chen, J. (2018). The National Intimate Partner and Sexual Violence Survey (NISVS): 2015 Data brief – Updated release. https://www.cdc.gov/violenceprevention/pdf/2015data-brief508.pdf
3. Karnitschnig, L. & Bowker, S. (2020). Intimate partner violence screening in the emergency department: A quality improvement project. Journal of Emergency Nursing, 46(3), 345-353.  https://doi.org/10.1016/j.jen.2020.02.008
4. Choo, E. & Houry, D. (2014). Managing intimate partner violence in the emergency department. Annals of Emergency Medicine, 65(4), 447-451. https://doi.org/10.1016/j.annemergmed.2014.11.004