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Sexual Assault Forensic Examiner Program Guidelines for the Care of the Sexual Assault Patient

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Sexual Assault Forensic Examiner Program Guidelines for the Care of the Sexual Assault Patient SEXUAL ASSAULT FORENSIC EXAMINER PROGRAM GUIDELINES for the CARE OF THE SEXUAL ASSAULT PATIENT Sexual Assault Forensic Examiner Program Office of the Attorney General 6 State House Station Augusta, Maine 04333-0006 207-626-8806 January 2011 (Page left blank intentionally) SEXUAL ASSAULT FORENSIC EXAMINER PROGRAM The following recommendations were developed by a subcommittee of the Sexual Assault Forensic Examiner Program Advisory Board. Reviewers included Sexual Assault Forensic Examiners, emergency department physicians, sexual assault support center advocates, and prosecutors. Many thanks to all who participated in the creation of the guidelines. Committee Members Polly Campbell, RN, SAFE Program Director Barbara Covey, MD Gloria DiSalvatore, RN, ME-SANE-A Dottie MacCabe, RN, ME-SANE-A Hannah Pressler, MHS, PNP Reviewers Deb Cashman, Assistant District Attorney Carmen Columbe, Assistant Attorney General Sue Hall Dreher, Executive Director, Sexual Assault Support Services of Midcoast Maine Nancy Fishwick, PhD, FNP, Director, School of Nursing, University of Maine Kathy Greason, Assistant Attorney General Robin Matthews, RN, SANE-A Gretchen Lajoie, Forensic Chemist II, Maine State Police Crime Laboratory Mary Lake, RN, ME-SANE-A Jeanette Michaud, RN, SANE-A Melissa O‘Dea, Assistant Attorney General Pam Poisson, RN, ME-SANE-A Tina Panayides, Esq. Kathy Parent, RN, ME-SANE –A Lois Skillings, RN, CEO, Midcoast Hospital Joni Sephton, RN, ME-SANE-A Janice Stuver, Assistant Attorney General Table of Contents (Page left blank intentionally) Sexual Assault Forensic Examiner Program Guidelines for the Care of the Sexual Assault Patient Table of Contents Introduction .................................................................................................... 1 What is a Sexual Assault Forensic Examiner? ..................................................1 What is the Need for the Guidelines ..................................................................1 Need for the SAFE Program .............................................................................2 Clinical Reference Guidelines Section I: Adult and Adolescent Patients .............................................. 3 Goals of the Sexual Assault Forensic Examination .................................................3 Criteria for Examination; Consent; Reporting Requirements ..................................3 Timing of Exam ................................................................................................3 Consent..............................................................................................................3 Sexual Assault Nurse Examiner/Scope of Practice ...........................................3 Mandated Reporting ..........................................................................................4 Intake........................................................................................................................4 Triage ................................................................................................................4 Assessment for Injury/Acute Medical Problems ..............................................4 Avoid Loss of Evidence ...................................................................................4 Call in Resources ..............................................................................................4 Protect Privacy, Comfort, and Confidentiality .................................................5 Examiner‘s Initial Contact with Patient ...................................................................5 Establish Rapport; Introduce Role of SAFE .....................................................5 History and Documentation .....................................................................................5 Relevant Legal Concerns ..................................................................................5 General Principles ............................................................................................6 Obtaining a history ....................................................................................6 Asking questions .......................................................................................6 Adolescent/Developmentally delayed patient ...........................................6 Documentation forms................................................................................6 Essential history components ....................................................................6 History of post-assault activities ...............................................................7 Medical history .........................................................................................7 Examination .............................................................................................................7 General Principles .............................................................................................7 i Medical Exam and Evidence Collection Integration of Medical and Forensic Exam ..............................................................8 Patient comfort .......................................................................................8 Conduct parallel medical/forensic exams ..............................................8 Avoiding evidence contamination .........................................................9 Ongoing consent ....................................................................................9 Components of the forensic exam..........................................................9 Double swab technique ..........................................................................9 Urine, Blood and Emesis Specimen Collection .......................................................9 When to Collect .....................................................................................9 Minors ....................................................................................................9 Timing .................................................................................................10 Method of collection ............................................................................10 Transport ..............................................................................................10 Packaging of Evidence, Chain of Custody, Kit Disposition ..................................11 Medical Treatment .................................................................................................11 Pregnancy Prophylaxis .......................................................................11 STD Prophylaxis ................................................................................12 Discharge Planning ................................................................................................13 Photodocumentation ..............................................................................................13 Documentation .......................................................................................................14 Billing ....................................................................................................................14 Quality Improvement ............................................................................................14 Section II: Pediatric Patients ..................................................................................15 Mandated Reporting...............................................................................................15 Use Available Resources .......................................................................................15 History....................................................................................................................16 Pediatric Exam – General Principles ....................................................................16 Pediatric Exam – Who to Examine ........................................................................16 Pediatric Forensic Examination .............................................................................17 Pediatric Examination – Head to Toe Assessment ................................................17 Pediatric Genital Examination ...............................................................................17 Prepubsecent Female &/or Young Adolescent Female ...................................17 Prepubescent Male/Young Adolescent Male ...................................................18 Medical Interview of the Child ..............................................................................19 Criteria for Focused Medical Interview .........................................................19 General Principles of the Medical Interview ..................................................19 Questions ........................................................................................................19 When NOT to Question ..................................................................................20 Pediatric Exam: Sexually Transmitted Diseases ....................................................20 Documentation .......................................................................................................21 Discharge Planning ................................................................................................21 ii Annotated Guidelines Introduction: The Problem ................................................................................................... 23 Incidence and Impact of Sexual Assault ................................................................23
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