# Presentation: 662082

## Documenting Intimate Partner Violence/Domestic ViolenceScreeningin RPMS

- Exam Code # 34  IPV/DV

## Domestic ViolenceGPRA 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

## 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

## 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

## 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

## 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!

## RPMS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

- 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

## 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

## 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

## 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 7)
- Exam
- Exam Value:  INT (or 34)
- Date Refused:

## 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

## Provider DocumentationContinued

- 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

## Provider DocumentationContinued

- 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

## Provider DocumentationContinued

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

## Future EnhancementsandDevelopment

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

##   IPV/DV Screening Exam CodeEnhancements

- 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

## 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

## 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