________________________________ Intimate Partner Violence: Compassionate Care, Effective Assessment
e. Complete medical history. f. Relevant social history. g. A detailed description of injuries and other relevant physical findings. Where applicable, the location and nature of injuries should be recorded on a body chart, drawing, or digital photograph. h. An opinion on whether the injuries were adequately explained or not.
• Take at least two pictures of every major trauma area. • Mark photographs precisely as soon as possible with the patient’s name, location of injury, names of the photographer and others present, and the date and time of the photograph. • To maintain chain of custody and confidentiality, be consistent as to where photographs are filed and who has responsibility for and access to photographs. • Arrange for the patient to return in two or three days for additional photographs to document the progression (and healing) of visible injuries. SEXUAL ASSAULT FORENSIC DOCUMENTATION AND EVIDENCE COLLECTION Documentary evidence of an attempted or completed rape can be collected up to five days after the crime occurs. Physi- cal evidence that can be used for medical assessment and possible criminal prosecution should be obtained using a Sexual Assault Forensic Evidence (SAFE) kit, which can be found in most hospital emergency departments. Unless the patient is unwilling or unable to present to the emergency department, the examination and evidence collection should be conducted in the emergency setting. An increasing number of hospital emergency departments use the services of Sexual Assault Nurse Examiners (SANE nurses) who have specific training in forensic nursing, evidence collection, and crisis counseling. If a patient calls your office before presenting to the emergency department, he or she should be told to refrain from showering, bathing, or douching before arriving at the hospital. Victims of sexual assault should be instructed to put all clothes worn during the assault in a paper bag to bring to the hospital as additional evidence. STRATEGIES FOR IMPROVING CARE FOR IPV VICTIMS EFFECTIVE COMMUNICATION STRATEGIES As important as it is to ask the right questions, it is equally important to refrain from asking questions in a manner that might frighten or intimidate your patient, increase the sense of humiliation and shame about the violence, or be interpreted as blaming the survivor for the situation. Here are some pitfalls to avoid [30]: • Do not inquire about abuse in the presence of the partner, friends, or family members. Children older than three should not be present while discussing IPV. • Discussing IPV can be very difficult and can leave patients feeling vulnerable. Do not inquire about abuse until the patient is fully clothed.
i. Documentation if the explanation of injuries given is inappropriate or inconsistent with the injury pattern. j. Documentation that the physician asked the patient about IPV, together with the patient’s response. k. Results of pertinent laboratory and other diagnostic procedures. l. If the police were called, the name, badge number, and phone number of the investigating officer and any actions taken. m. Name of treating health care provider(s). The EMR can facilitate interviews and a template can be created to ensure all of the above pertinent information is obtained. Make sure the patient knows how to access their records, and also that the patient knows the document is confidential, thus requiring their permission or a subpoena for the partner or anyone else to view it.
DOCUMENTING ABUSE WITH PHOTOGRAPHS
In addition to complete written records, photographs can be of particular value as evidence. Additional imaging studies may be useful, depending on the clinical situation. The physician should obtain written consent for photographic documenta- tion from the patient prior to taking photographs. Digital images should be dated and signed by the physician (freehand or electronic signature), and accompanied by a statement that indicates that the images are authentic and unaltered. Techniques for optimal photographic documentation include: • Whenever possible, take photographs before medical treatment is provided. • Photograph from different angles, full body, and closeup. • Hold up a coin, ruler, or another easily identifiable object to illustrate the size of an injury. • Include a date marker on the photograph. If not available from within the camera, that day’s newspaper or other dated material may be used. • Include the patient’s face in at least one picture and some identifiable part of the patient in all photographs.
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MDFL0627
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