2.50
Hdl Handle:
http://hdl.handle.net/10755/306587
Category:
Abstract
Type:
Poster
Title:
Targeted Rapid HIV Testing in a Pediatric Emergency Department (PED)
Author(s):
Volz-Noe, Pamela; Lippe, Joyce; Hehman, Michelle; Bracco, Ellen; Nelson, Morgan; Holland, Carolyn; Eckerle, Michelle; Robinson, Venita; Brown, Angela
Lead Author STTI Affiliation:
Non-member
Author Details:
Pamela Volz-Noe, MEd, BSN, BS, RN, pamela.volz-noe@cchmc.org; Joyce Lippe, MD; Michelle Hehman, BSN, RN, Ellen Bracco, BSN, RN, Morgan Nelson, RN; Carolyn Holland, MD, MEd; Michelle Eckerle, MD; Venita Robinson, MHSA; Angela Brown, APN, RN
Abstract:

Evidence-based Practice Abstract

Purpose: The CDC estimates that over half of adolescent and young adult patients are unaware of their HIV status. As unaware patients are responsible for the majority of all new HIV infections, the CDC recommends that all patients with concern for any sexually transmitted infection (STI) be tested for HIV at that visit. Despite these recommendations, fewer than 3% of patients presenting to our PED with complaints or symptoms suggestive of STI were tested for HIV. We aimed to increase the percentage of patients with a documented offer of an HIV test from less than 3% to 90% by December 31, 2012.

Design: A cross sectional, quasi experimental design was used.

Setting: A 44 bed Emergency Department Inner city Level 1 Pediatric Trauma Center in a Midwestern State.

Sample: All patients who present to the ED with complaints and/or symptoms of STI.

Methodology: We designed a theoretical model for rapid HIV testing in the ED, created a key driver diagram, and designed interventions based on those key drivers. Initial interventions included elimination of our institution’s written consent requirement for HIV testing, training PED nursing staff to perform rapid HIV tests point-of-care (POC), establishing relationships with specialists to facilitate linkage-to-care for patients with preliminary positive results, and creation of documentation aids in our electronic medical record (EMR). Run charts were used to track testing rates over time; standard rules for run chart interpretation were used to determine the occurrence of statistically significant change. Pareto charts guided our focus in further interventions. To increase appropriate identification of targeted patients, and increase awareness and value of HIV testing, we provided ongoing education to care providers and patient services staff at all levels, and encouraged a culture of shared responsibility in which any member of the health care team could recommend HIV testing. We continuously incorporated feedback and revised our testing model as needed.

Results: As evidenced on our annotated run chart, with the start of POC rapid HIV testing on January 10, 2012, testing rates in our target population increased from less than 3% in the baseline period to a peak of 88%, with sustained rates of 60-85% over several months. The majority of patients offered an HIV test agreed to testing, with the most common reason for test refusal being a recent negative test.

Conclusions: We have made significant progress towards designing a system capable of identifying patients at-risk for HIV and offering them appropriate testing in the PED, but have not yet achieved our goal. We have concentrated efforts on designing interventions with a higher level of reliability, and are currently creating a “Best Practice Alert” (BPA) in our EMR, which will be triggered when a provider orders STI tests but does not include HIV. The BPA will allow providers to order HIV (and other standard STI tests not ordered), if appropriate, from the BPA itself, and will allow providers to easily document reason(s) for not pursuing HIV testing.

Keywords:
Pediatric ED HIV Testing
Repository Posting Date:
9-Dec-2013
Date of Publication:
9-Dec-2013
Conference Date:
2013
Conference Name:
2013 ENA Annual Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Nashville, Tennessee, USA
Description:
2013 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at Gaylord Resort and Convention Center
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePosteren_GB
dc.titleTargeted Rapid HIV Testing in a Pediatric Emergency Department (PED)en_GB
dc.contributor.authorVolz-Noe, Pamelaen_GB
dc.contributor.authorLippe, Joyceen_GB
dc.contributor.authorHehman, Michelleen_GB
dc.contributor.authorBracco, Ellenen_GB
dc.contributor.authorNelson, Morganen_GB
dc.contributor.authorHolland, Carolynen_GB
dc.contributor.authorEckerle, Michelleen_GB
dc.contributor.authorRobinson, Venitaen_GB
dc.contributor.authorBrown, Angelaen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsPamela Volz-Noe, MEd, BSN, BS, RN, pamela.volz-noe@cchmc.org; Joyce Lippe, MD; Michelle Hehman, BSN, RN, Ellen Bracco, BSN, RN, Morgan Nelson, RN; Carolyn Holland, MD, MEd; Michelle Eckerle, MD; Venita Robinson, MHSA; Angela Brown, APN, RNen_GB
dc.identifier.urihttp://hdl.handle.net/10755/306587-
dc.description.abstract<p>Evidence-based Practice Abstract</p><p>Purpose: The CDC estimates that over half of adolescent and young adult patients are unaware of their HIV status. As unaware patients are responsible for the majority of all new HIV infections, the CDC recommends that all patients with concern for any sexually transmitted infection (STI) be tested for HIV at that visit. Despite these recommendations, fewer than 3% of patients presenting to our PED with complaints or symptoms suggestive of STI were tested for HIV. We aimed to increase the percentage of patients with a documented offer of an HIV test from less than 3% to 90% by December 31, 2012.</p><p>Design: A cross sectional, quasi experimental design was used.</p><p>Setting: A 44 bed Emergency Department Inner city Level 1 Pediatric Trauma Center in a Midwestern State.</p><p>Sample: All patients who present to the ED with complaints and/or symptoms of STI.</p><p>Methodology: We designed a theoretical model for rapid HIV testing in the ED, created a key driver diagram, and designed interventions based on those key drivers. Initial interventions included elimination of our institution’s written consent requirement for HIV testing, training PED nursing staff to perform rapid HIV tests point-of-care (POC), establishing relationships with specialists to facilitate linkage-to-care for patients with preliminary positive results, and creation of documentation aids in our electronic medical record (EMR). Run charts were used to track testing rates over time; standard rules for run chart interpretation were used to determine the occurrence of statistically significant change. Pareto charts guided our focus in further interventions. To increase appropriate identification of targeted patients, and increase awareness and value of HIV testing, we provided ongoing education to care providers and patient services staff at all levels, and encouraged a culture of shared responsibility in which any member of the health care team could recommend HIV testing. We continuously incorporated feedback and revised our testing model as needed.</p><p>Results: As evidenced on our annotated run chart, with the start of POC rapid HIV testing on January 10, 2012, testing rates in our target population increased from less than 3% in the baseline period to a peak of 88%, with sustained rates of 60-85% over several months. The majority of patients offered an HIV test agreed to testing, with the most common reason for test refusal being a recent negative test.</p><p>Conclusions: We have made significant progress towards designing a system capable of identifying patients at-risk for HIV and offering them appropriate testing in the PED, but have not yet achieved our goal. We have concentrated efforts on designing interventions with a higher level of reliability, and are currently creating a “Best Practice Alert” (BPA) in our EMR, which will be triggered when a provider orders STI tests but does not include HIV. The BPA will allow providers to order HIV (and other standard STI tests not ordered), if appropriate, from the BPA itself, and will allow providers to easily document reason(s) for not pursuing HIV testing.</p>en_GB
dc.subjectPediatric ED HIV Testingen_GB
dc.date.available2013-12-09T17:00:16Z-
dc.date.issued2013-12-09-
dc.date.accessioned2013-12-09T17:00:16Z-
dc.conference.date2013en_GB
dc.conference.name2013 ENA Annual Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationNashville, Tennessee, USAen_GB
dc.description2013 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at Gaylord Resort and Convention Centeren_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.en_GB
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