ENA Connection - September 2016

Similarly, the video educates patients on the path of the sexual assault kit, should they pursue a subsequent criminal charge.

With a nationwide backlog of rape kits, only those with an attached crime report are reviewed.

Offering Financial Assurance

Patients also worry about paying for the sexual assault exam or ED visit. This increasingly enters the equation as outreach about sexual assault on college campuses has yielded more reports from undergraduates. College and high school students frequently question clinicians on the rules about informing parents or express reluctance to undergo a sexual assault exam, lest parents discover the incident by receiving an insurance bill.

With patients’ financial burdens so often discussed, nurses insisted the video include information about Pennsylvania’s Victims Compensation Assistance Program.

“Because of this law, all aspects of the sexual assault exam are fully compensated and no patient ever receives a bill,” said Tammy Bimber, MSN, RN, CEN, SANE-A/P. “It covers any evidence collection and prophylactic medication for sexually transmitted disease.” As the program covers only the exam and minor injuries that don’t require X-ray testing, some related procedures – such as CT scans for patients who were unconscious during the assault – are billed. Here too, it’s emphasized that patients have options as far as how to proceed.

“Every patient decides for himself or herself whether insurance should be billed or not,” Bimber said.

Fighting STDs and Unwanted Pregnancy

While nurses communicate throughout the film about the patient’s right to choose, they also accentuate the importance of getting a timely prophylactic medication.

“Statistically, we know the chances of seeing victims again is low post-discharge,” Simonian said. “We want to give the first dose of the prophylactic as soon as possible in the ED to prevent gonorrhea or chlamydia. We can start the series for hepatitis B in the ED, but it requires follow-up. If the patient has a high risk for HIV, we start on a 30-day prophylactic, but it requires follow-up.” Approximately 98 percent of patients facilitywide opt for the morning-after pill. “If there’s one thing they’re looking for, it’s emergency contraception,” Simonian said. Still, approximately 5 percent of patients nationwide become pregnant after a sexual assault.

In addition to educating patients and informing the community about UPMC resources, the video may further increase the exposure of SANEs. “Our video has been very well-received, and we’ve had a lot of interest from colleagues in patient advocacy, law enforcement and academia,” Krasneski-Schreiber said. n