Documenting Intimate Partner Violence Domestic Violence Screening in RPMS

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Documenting Intimate Partner Violence/Domestic
ViolenceScreeningin RPMS

• Exam Code 34 IPV/DV

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Domestic ViolenceGPRA Clinical Performance
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

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Clinical Reporting System (CRS)(formerly known
as GPRA )

• Currently sites will receive credit for
  documentation of
• IPV/DV Screening Exam Code 34
• IPV/DV related POV
• DV Patient and Family Education Code
• Preferred method of documenting is with the
  IPV/DV Screening Exam

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Clinical Objectives

• Objective
• IPV/DV Screening
• Standard
• Adult females should be screened for domestic
  violence at a new encounter and at least
  annually
• prenatal patients should be screened once each
  trimester
• Source Family Violence Prevention Fund

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Why Screen?

• US Preventive Services Task Force (USPTF) asserts
  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 worsen

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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!

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RPMSIPV/DV ScreeningExam Mnemonic EX 34 or
IPV Screen

• AUM 4.1 Patch 1 AUPN Patch 11 Released Nov 03

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IPV/DV Screening in RPMS

• Screening results are recorded as an exam
• Providers and Data Entry staff should work
  together to develop the preferred method of
  documentation Providers need to know how/where
  to record results DE needs to know where to look
  for documentation
• Date of screen and providers initials only appear
  on Health Summary patient safety

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IPV/DV Screening in RPMS

• PCC
• POV
• Stamp
• PCC
• BH applications (BHS v3.0 and BH GUI)
• Direct clinical data entry of screening results
  when recording a visit
• Currently PDE, SDE RDE in BHS v3.0 patch 4
  (April 2005)
• Wellness tab in BH GUI (v1.5 release April 2005)
• IHS Electronic Health Record
• Direct clinical data entry
• Wellness Tab

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IPV/DV Screening 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

11
EX 34Data Entry

• Refusals Mnemonic REF
• Exam
• Exam Value INT (or INT)
• Date Refused

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EX 34Data Entry

• Unable to Screen
• Mnemonic UAS (PCC Data Entry patch 7)
• Exam
• Exam Value INT (or 34)
• Date Refused

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Provider Documentation

• Allowable Results
• 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

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Provider DocumentationContinued

• Unsuccessful attempts to screen should also be
  recorded
• Refused (REF)
• patient declined exam/screen
• Unable to screen (UAS)
• acceptable reasons for UAS include partner
  present, verbal child present

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Provider DocumentationContinued

• Results can be recorded in the POV section of the
  PCC
• POV DV/IPV Screen Negative, TC (provider
  initials)
• or
• POV EX 34 UAS, partner present, TC

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Provider DocumentationContinued

• Results can also be recorded by using a stamp on
  the PCC form or
• PCC developed template
• Insert sample stamp/table here

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Future EnhancementsandDevelopment

• IPV/DV Screening Exam Code
• PCC Management Reports
• Health Maintenance Reminder

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IPV/DV Screening Exam CodeEnhancements

• Initials (patch released)
• Ordering Provider added to DE template
• Important because Provider who screened is not
  always the Primary Provider of visit
• Capture general Comments (released)
• Allows provider to document other useful clinical
  information

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PCC Output Reports

• Tally and listing of all patients receiving
  IPV/DV screen including refusals, sort by
• Date range
• Age
• Gender
• Result
• Provider (of exam, if available Primary Provider
  of Visit, PCP)
• Date
• Clinic
• POV
• Plus other similar reports
• Similar reports also available in BHS v3.0 (RPMS
  Behavioral Health

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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 data)
• Frequency Standard is annual once per
  trimester for prenatal and a post-partum