(From the Spring 2013 issue of Everything Matters: In Patient Care)
Kandi Valentine, RN, BA, BSN, MSN, RN Clinical Leader, Emergency Department
The Columbus Coalition Against Family Violence worked collaboratively with Central Ohio Trauma Systems (COTS) to develop family violence screening protocols that could be used in hospital emergency departments. This screening is used to identify and assist victims of family violence while they are still present in the Emergency Department (ED). The information within the screening tool is a required part of the nursing assessment for the ED. This initiative, started in 2006, continues in the ED at Nationwide Children’s Hospital today. The delivery of the screening has evolved over the years from a paper questionnaire to a computerized kiosk dedicated solely to the screening process.
In the early implementation phase, a paper form questionnaire was provided to families by the caregiver. Once completed, the family returned the questionnaire to the intake nurse. The intake nurse would preview the answers to the screening and page the ED social worker for any positive screenings. Several challenges were identified with this process. First, the demand on the intake nurse became cumbersome during peak volume times which caused delays in reviewing the paper screening forms. Second, the social worker was often with other patients and families when he or she was notified by the intake nurse of a positive screening. This created interruptions for other families when the social worker was required to call triage in order to find out the nature of the page. Third, there was sometimes a delay in reaching the family before they were discharged home. Finally, there was doubt that all families had the opportunity to complete the questionnaire in a confidential, safe and honest manner. In addition, if the perpetrator was present, this created a barrier to effective screening.
In 2009, a pilot using a self-standing kiosk began in the ED as part of a research project driven by staff at the Center for Child and Family Advocacy, that is now known as The Center for Family and Safety Healing. The kiosk was set-up to increase the confidential collection of family safety information, to collect blinded data to determine actual family participation in the screening process and to gather data regarding identification and follow-up for positive screens. The kiosk was convenient for the family as the bar code on the form provided by the intake nurse and the bar code on the patient’s ID band could both be used to access the system and to complete the screening. The family could also choose to visit the kiosk in a more private and safe manner and at their own pace if the perpetrator was present with them in the ED. A huge benefit of this kiosk in clinical practice is that the social worker was automatically notified in real time of a positive screen, enabling timely interaction with the family.
The overall success of the kiosk for family safety screens was recognized in the ED. This process proved to be convenient for families, provided timely notification to the social worker and streamlined manual processes for nursing staff. In addition, the data collected for the research study showed promise that families were being identified and provided with additional resources to increase family safety within the population served by the ED. The kiosks were donated to the ED for continued use following the completion of the research project.
With the move to the new main hospital, ED leadership decided that the use of the kiosk should continue in the new ED. After collaboration with key stakeholders it was determined that the new ED would house two kiosks designated for safety screening. An area was specifically constructed to house the kiosks in the lobby area where the family could sit down and complete the safety screen. The safety screen is encouraged by the intake or assessment nurse and built into the flow of assessment for the patient. ED social workers are well versed in the sensitivity of family safety in their approach when a screening is recognized as positive.
Family safety is a priority at Nationwide Children’s. We are dedicated to holistically serving the children and families who come to the ED. A visit to our ED may be one of the few opportunities to interact with a family who may be victims of unsafe living environments. Many of us often say we enter health care because we like to help others. With the touch of the safety kiosk button, we are able to perfect our ability to do just this.