Documenting Intimate Partner Violence Domestic Violence Screening

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					Documenting Intimate Partner
    Domestic Violence
         in RPMS

       Introducing the RPMS
   IPV/DV Screening Exam Code
         GPRA (CIRS)
   Domestic Violence Indicator

 During FY 2005, the IHS will ensure that 15%
  of women between the ages of 15 and 40 are
  screened for domestic violence.

 During FY 2004, the IHS will address domestic
  violence, abuse and neglect by screening at
  least 15% of eligible women patients between
  the ages of 16-24 for domestic violence at
  direct care facilities
          Clinical Objectives

 Objective – IPV/DV Screening

 Standard – Adult females should be screened
  for domestic violence at a new encounter and
  at least annually; prenatal once each trimester
  (Source: Family Violence Prevention Fund
  National Consensus Guidelines)
                Why Screen?
 US Preventive Services Task Force (USPTF)
  acknowledges that the effectiveness of screening has
  not been validated, however, they also state that
  screening is justifiable on other grounds including:

      High prevalence of undetected abuse among female patients
      Low cost and low risk of screening
      Adverse economic and social impact of abuse
      DV is a chronic, life-threatening condition that is treatable; if
       abuse is left untreated the severity and frequency of abuse can
               Why Screen?
 DV screening is recommended by:
      American Academy of Family Physicians
      American College of Physicians
      American Medical Associations
      American College of Obstetricians and Gynecologists
      DV Screening is a JCAHO Mandate

 JCAHO Mandate

 GPRA Clinical Performance Indicator

 Women want to be asked!
      IPV/DV Screening
   Exam Mnemonic: EX 34
        or IPV Screen

AUM 4.1 Patch 1; AUPN Patch 11
       Released Nov „03
      IPV/DV Screening
          in RPMS
 IPV/DV Screening will be conducted as an
  “exam” within a visit
 Providers should work with Data Entry staff to
  ensure that proper documentation and coding
 Screening results can be entered on a PCC
  (patient encounter) with a stamp or pre-print;
  Behavioral Health providers can enter
  electronically via the RPMS BH applications
    Current IPV/DV Screening
           Exam Code
              Data Entry

 Exam Mnemonic: EX 34 or IPV Screen
  (AUM 4.1 patch 1; AUPN patch 11)
 Allowable results:

  N     Negative
   PR   Present
   PA   Past
                EX 34
              Data Entry

 Refusals Mnemonic: REF

   Exam
   Exam Value: INT (or INT)
   Date Refused:
                EX 34
              Data Entry

 Unable to Screen
 Mnemonic: UAS (PCC Data Entry patch
   Exam
   Exam Value: INT (or 34)
   Date Refused:
IPV/DV Screening Exam Code # 34
     Provider Documentation

 EXAM – DV (or IPV) Screen
   Negative – denies being a current or past
    victim of DV
   Present – admits being current victim of DV
   Past – denies being a current victim, but
    admits being a past victim of DV
     Provider Documentation

 Providers should always document
  unsuccessful attempts to screen using
  the mnemonics REF and UAS

   Refused – patient declined exam/screen

   Unable to screen -- acceptable reasons for
    UAS include partner present, verbal child
  Proposed RPMS IPV/DV Screening
 Documentation and Data Collection

 IPV/DV Screening Exam Code

 PCC Management Reports

 Health Maintenance Reminder
  Requested Enhancements to
  IPV/DV Screening Exam Code

 Initials – who administered the exam
  (“Ordering Provider” added to DE
 Capture comments (245 characters)
   for Exam results (Negative, Present, Past)
   for Refusal
   for Unable to Screen
     PCC Management Reports
         IPV/DV Requests

 Date Range
 Age Range
 Count by Provider
 Count by Response (N, PR, PA)
 List of Exam Results with comments (Do we
  want option of listing with patient identifier?)
 Sort by ?? (community, tribe, location of
  encounter, clinic, etc.)
 Need firm specifications for programmer
    Development of IPV/DV
 Health Maintenance Reminder

 Display on Health Summary
   Screen on Gender
   Screen on Age
   Screen on current dx of pregnancy; key off
    of EDC (problematic because of persistent
 Frequency – Standard is annual; once
  per trimester for prenatal