Best Wishes to SANEs for a Happy New Year

The end of 2012 is almost here - and we have alot to be grateful for!  I am grateful for each of the MUSC SANEs, you put so much of yourselves into this program.  Without you it could not succeed, or provide care for our patients.  Your care is calming to the patient and family, and critical to the team. Thank you to each one of you, for being a member of the team, for sticking with it, and for looking ahead with me to a great 2013.  We will be getting our new camera system, continuing to build our reputation and presence in the community, and providing excellent care for those who have experienced terrible violence.  My best wishes for a safe and Happy New Year to you all!

Emergency Contraception

Plan B is levonorgesterel, and is provided in either a 1.5 mg (one time dose) or 0.75mg (2 doses given 12 hours apart, or can both be taken at the same time).  Both are also available over the counter for women (and men) age 17 and older.  Plan B is most effective within the first 72 hours, but can be given up to 120 hours post-exposure.

Click on this link to see a unique video describing how Plan B works:   http://www.youtube.com/watch?feature=player_embedded&v=7Vozr9vHeMo

Even if a woman has been on oral contraception or been taking Depo-Provera, it is ok to offer Plan B after a sexual assault.    Some women do not take their pills consistently on time, or get their Depo shots on time.  If you do not give Plan B in a case of vaginal/penile penetration, please document that you offered it, and patient declined (and why).  Plan B is safe to give women who are breastfeeding.  To minimize the infant's exposure to levonorgesterel, advise the woman to avoid nursing her infant for 8 hours. 

Patient Teaching Points:

• It is possible to become pregnant after a sexual assault.
• The medication is most effective when taken as soon as possible.
• Only contraindication is pregnancy.
• Most common side effect is heavier menstrual flow.
• Routine use of antiemetics is usually not necessary.
• Plan B will not protect against STI's.
• Plan B can be used safely more than 1 time during a menstrual cycle, but should not be considered first line of defense against pregnancy.  A visit to a primary care clinic is advised for education and contraception planning.

Current Stats on HIV Infections in Males

The CDC just published the latest data for the Charleston area on HIV infections for persons aged 13 and older.  In Charleston (2010), 63.5% of HIV infections are associated with male to male sexual contact.  Please remember to offer HIV screening to your patients, and help them with an assessment of risk for acquiring HIV from a sexual assault.  Dr Lazenby will see male patients at risk for HIV related to sexual assault.

New Equipment!

Our new photography lights have arrived!  These are 2 LED light boxes on tripods, used for professional photography.  With one on each side of the bed you should be able to photograph injuries with more "natural daylight" and have better outcomes.  They are easy to use, labeled and ready for you.  Each one has batteries, but there is an AC adaptor (in the cart) in case we need to take them "on the scene"!  Please let me know how you like them.

National Forensic Nurse Week

National Forensic Nurses Week is Nov. 11-17, 2012.  The service you provide to victims and their families is critical to their healing, vital in your community, and valuable to MUSC.  Thank you for your dedication, time away from home, the nights you stay up, the weekends you spend at the hospital, the chance for healing you give to the victims you serve.  Look at the MUSC Facebook page for info about sexual assault!  We have made the big time!

IAFN has produced some great videos about forensic nursing.  Take a moment to refresh yourself, acknowledge your own Greatness, and celebrate your work by watching a few videos.  This link will take you to the IAFn webpage, then click on  Forensic Nursing Documentary to see the videos.  Thank you to all MUSC SANEs!

SA and Risk of HIV Transmission

A notice has been posted in the exam with this info.  This should help guide you in counseling your patients that may be at high risk for HIV transmission.  It is based on assault facts, injury status and assailant status.   There is additional info in the SANE reference book. 

HIV TRANSMISSION EXPOSURE

Type of Exposure	Estimated Risk
Anal penetration with HIV + source	0.5% (1 in 200) – 3.0% (6 in 200)
Vaginal penetration with HIV + source	0.1% (1 in 1000) – 0.2% (2 in 1000)
Oral penetration with ejaculation from HIV + source	Risk considered to be low, no conclusive data exists

FACTORS THAT INCREASE RISK OF HIV TRANSMISSION

1.      Genital mucosal injury with anal or vaginal penetration

2.      Assault by multiple assailants

3.      Assailant who: is male having sex with men, has STI’s, is an IV drug user, has multiple sex partners, trades sex for drugs and/or money

ADVISE PATIENT TO CONSULT DR LAZENBY IF:

1.      Assault occurred within the past 72 hours.

2.      Patient/or assailant characteristics meets the above risk factors

TO REACH DR LAZENBY:

1.      Between 0700 and midnight,  Page Dr L at ID # 14681

2.      After midnight email her at lazenbgb@musc.edu with patient name, MRN, phone number, date of birth and pharmacy info.  Send same info to Nancy Hall at hallnj@musc.edu

3.      Notify SANE office that pt has been referred to DR Lazenby for HIV nPEP

SANEs and CODIS

Election Day - I hope everyone is able to get to their local polling station to take part in our demonstration of democracy!!  Regardless of your political leanings - I believe it is important to vote.  We can easily take for granted the efforts of a handful of women who risked everything to be sure that we would have a chance to speak our minds!

Great news from Charleston Police Department: MUSC SANEs have helped to pull a dangerous criminal off the streets!  Because of the work of our SANEs, 5 individual sexual assaults have been linked to one person.  That person was identified from the FBI's DNA database: CODIS.  CODIS stands for Combined DNA Index System. There are over 10 million DNA profiles, all are anonymous, joined by numbers to protect individual identity until a match occurs.  Offenders who have been incarcerated are required to provide buccal swabs or blood so their profiles are loaded into CODIS.

Samples from the kits we collect are analyzed by SLED, and the unknown profiles are entered into the CODIS system.  The data is renewed weekely on a national level, so our unknown profiles are compared against data entered from all 50 states, hoping for a match.   Once a match occurs, the information is released to the appropriate law enforcement agency. This summer, 3 MUSC SANE cases were submitted to CODIS database - and all returned the same "hit".  An additional 2 assaults were later linked to the same profile.  That person is now behind bars - awaiting trial.


FYI:
Please remember to fill out the Case Study #1 and bring to Janette's for our next meeting.  I have yet to figure out how to load the link here, but if you need a copy, email me and I will send it. 

Did you find the guest speaker at the last meeting valuable?  Is that something you would like to continue?  What topics do you want to see addressed in the future?  Let us know!

October Staff Meeting

If you were not present for the meeting, please make a comment to document that you have read them.

MUSC SANE program

October 2012 Meeting Minutes

Present: Kathy Gill-Hopple, Janette Ward, Whitney Simpson, Nicole Wolf, Melissa Leslie, Stephanie Green, Lynze Eades, Brooke Bae, Jennifer Griffin

1.    Announcements made:

a.    www.muscsane.blogspot.com is the site of the new blog.  Everyone was sent an invitation.  Please look for policies, news and helpful information.  Comments and suggestions are welcome.

b.    Next meeting is business/Christmas at Janette’s house.  Electronic invitations will be sent out.  All food will be provided with an Italian theme.  If you wish to participate you can bring a Christmas tree ornament for exchange.

c.    Call calendar – still in evolution.  Daytime hours (7a-3p) will be covered by the office staff, unless other arrangements have been made.  There will still be plenty of opportunities for all SANEs to pick up hours.  Please notify the office of your November schedule as soon as possible.  Also need Thanksgiving covered.  It is still expected for SANEs to pick up 6 hours on a holiday.

d.    Community Resource sheets have been prepared by Janette.  Please utilize them for each patient and choose the appropriate brochures for the patient’s situation.

e.    A rolling suitcase is being purchased for the “away” cases.  The suitcase will store all the needed equipment, so you will only need to pick it and the camera (when it arrives) up.  Requests for exams in other hospitals will be approached on an individual basis.  Please call Kathy or the office when you have received a request to go to another hospital.  We will facilitate the request.

2.    Guest speaker: Kimberly Purdue from South Carolina Legal Services spoke about orders of protection, and free assistance to fill them out at the Charleston court house on Fridays 9am – 1pm. 

3.    CV’s – must be completed and returned to Kathy.  These will be filed at the courthouse and updated on a yearly basis.  This is your documentation of your ability to act as an expert witness.  A template is posted on the blog.  If you have the info in another format please send it on to Kathy.

4.    Anonymous reporting – the law says that victims must be offered the opportunity to receive a medical forensic exam without being required to pay for it, and without being required to notify law enforcement.    The anonymous report numbers will now be the Pat Com number that is assigned to the patient when they register into the hospital.  The only documentation to be on the outside of the kit is:  Pat Com number

                                             Date of the exam

                                             Date of “expiration” 1 year from date of exam

                                             SANE signature and “MUSC”

5.    Unit competencies:  The Anatomical Review list and Case Study #1 was distributed.  Case Study is to be completed and returned at the next staff meeting: Nov. 27.  Unit competencies meet the requirement for ongoing education.  They must be completed – no exceptions.

6.    Patient Follow up calls will be made from the SANE office beginning Nov 1.  These will be health-care focused, and provide an opportunity for the patient to ask questions and receive additional support.  Please verify 2 (if possible) good phone numbers and ask if it is ok to leave messages.  Please tell your patient she/he will be receiving a FU call within a couple of days.

7.    2013 Peer Review – Request was made for an on call SANE to help with the development of a peer review tool.  Please notify Kathy if you are interested.

8.    Suggestion was made to have a group try to attend the next EVAW conference in Maryland.  MUHA Giving Back grants can be applied for to help pay the costs by individuals.  Other future training opportunities:

a.    Adv. Forensic Photography,  Nov. 14, 2012, 8:30-5:00 Midlands Technical College, Lexington Hall Room 185, 1260 Lexington Dr. West Columbia, SC

b.    Evidence Collection, Preservation & Submission, Dec. 10, 2012,8:30 – 4:00 Lexington Police Dept, 111 Maiden Ln, Lexington, SC

A link has been attached to the most current STI Treatment Guidelines from the CDC.  Please refer to this document for any questions about treatment of STI's.  There is a section specific to sexual assault, but the primary info listed for each infection is in great detail.

SANE Info Needed!

Please fill out a curriculum vitae (CV) - so that we will be up to speed when needed for court testimony.  Take time to look over all of your previous education, formal and continuing ed.  The CV is how you demonstrate your education and experience, so that you may be qualified as an expert witness. 

Completion of this form is a MUST.  If you already have a CV - different than a resume - we will accept that.   You can cut and past the template into a word document then email it to me.  I will maintain them, and you will be asked to update yearly.  Any questions - ask Kathy!

Name

MUSC SANE Program

169 Ashley Ave

Charleston, SC 29425

(843) 729-3391

Education

Year                                       School                                                                                   Degree/Certification

Professional Certifications (example RN license, ACLS. PALS, BLS etc)

Year                                       Name of Certification or License and number if applicable

Employment

Year                                       Location                                                                               Job Title

Continuing Education Taught

Year                                       Title and Location                                                                            

Continuing Education Received

Year                                       Title and Location                                                                            

Publications

Year                                       Title and Location            

                                                               

Professional  Memberships/Associations

10/23/2012  A new informational packet has been developed by the Pennsylvania Coalition Against Rape on Sexual violence and individuals who identify as LGBTQ.  This may be a useful resource when you least expect it!  Check out the info at:
http://www.nsvrc.org/publications/nsvrc-publications-information-packets/sexual-violence-individuals-who-identify-lgbtq

Check out the Facebook page of the Tri-County Domestic Violence Coordinating Council!  THis group meets the 3rd Wednesday of every month at 3pm in North Charleston City Hall.  MUSC has a great presence there- with reps from the SANE program and the College of Nursing.  In fact, MUSC is the only hospital in attendance!

WAY To GO MUSC!!