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Archive for the ‘Needlestick’ Category

BBFE Orders

Please use the Sexual Assault order set when sending labs on patients with a blood or body fluid exposure to ensure that the correct labs are sent.

We recently had several cases of incorrect hepatitis profiles ordered. If you type in “needle stick” (with a space) or “sexual assault” the order set “Sexual Assault aka needle stick” will come up. We are working with EPIC to have a separate order set in the future.

Thank you,

Denise

Written by phil

January 3rd, 2013 at 8:16 pm

Posted in Needlestick

New BBFE Flowsheet

As of today, the multiple old needlestick / blood & body fluid exposure forms have replaced by a single document that was re-written from scratch collaboratively with ID, nursing admin, and employee health. This new flowsheet is designed to successfully guide your psychiatry intern through the process at 3am without any input from you.

You can find it in the Documents section of Epic, see attached.

It can also be viewed (and printed) using this link:

http://goo.gl/DLp4E

Let me know if you have any questions.

reuben

Written by reuben

March 8th, 2012 at 2:54 am

Posted in Needlestick

HIV testing no longer requires written consent

And patients who are sources in needlestick cases who cannot consent, in some cases can be tested without consent. See the document link below.

August 11, 2010
TO: (New York State)
Chief Operating Officers
Medical Directors
Emergency Medicine Chairs
Emergency Department Administrators
Legal Affairs Committee

FROM: Susan C. Waltman, Executive Vice President and General Counsel

RE: Enactment of Bill to Promote HIV Testing

On July 30, 2010, Governor David Paterson signed into law S.8227/A.11487, which allows patients to agree to HIV testing as part of a general signed consent to medical care that remains in effect until it is revoked or expires. The law also requires health care providers, including hospitals and emergency departments, to offer testing to all patients between 13 and 64 years of age, as recommended by the Federal Centers for Disease Control and Prevention (CDC), and facilitates authorization for testing in the case of certain occupational exposures to HIV infection. The new law takes effect September 1, 2010, but authorizes the New York State Commissioner of Health to adopt regulations necessary to implement the law prior to that date.

The law will require a number of operational changes within health settings, including: hospital inpatient areas, emergency departments, outpatient departments, as well as other primary care settings. To assist its members, GNYHA is working with the New York State Department of Health (DOH) to identify and address the barriers and burdens that these requirements will create for providers. GNYHA will keep you apprised of its progress on these efforts.
The law aims to increase HIV/AIDS testing rates so that individuals who are HIV-positive can seek treatment earlier and reduce transmission of the disease to others. The law, therefore, updates New York State’s laws to encourage such testing and to reflect medical technologies and advances.

Overview of Law

The following provides a summary of the main features of the law:

Testing – Requires that an HIV-related test be offered to every individual between 13 and 64 years of age (or younger/older if there is evidence of risk activity) receiving health services as an inpatient or in the emergency department of a hospital or receiving primary care services in the outpatient department of a hospital or freestanding diagnostic treatment center or from a physician, physician assistant, nurse practitioner, or midwife providing primary care. Such offering must be “culturally and linguistically appropriate.”

Consent to Testing – Authorizes HIV-related testing to be part of a signed general consent to medical care or documented oral consent when the test being ordered is a “rapid HIV test.” Such consents would be durable and remain in effect until they are revoked or expire. Patients must be provided an opportunity to decline HIV testing, and testing may only be done with full patient consent after the patient is provided with pre-test counseling information. In all instances, a physician must provide oral notification to the patient whenever an HIV test is performed and the notification must be noted in the patient’s medical record.

Occupational Exposures – In situations involving occupational exposures that create a significant risk of someone contracting or transmitting HIV infection, HIV testing will be allowed in cases where: (1) the source person is deceased, comatose, or unable to provide consent, and his or her health care provider determines that mental capacity to consent is not expected to be regained in time for the exposed person to receive appropriate medical care, as determined by the exposed person’s health care provider; (2) an authorized representative for the source person is not available or expected to become available in time for the exposed person to provide appropriate medical care; and (3) the exposed person would benefit medically by knowing the source person’s HIV test results.

HIV Counseling – Require that HIV counseling messages be tailored based upon whether the HIV test indicates infection. Required positive test counseling remains consistent with existent law, but positive test counseling will now require the person ordering the test to provide or arrange for follow-up medical care if the patient consents. In cases with negative test results, counseling can be accomplished via oral or written reference to information previously provided but must emphasize the risks associated with high-risk behaviors.
Consent Forms – Designates the informed consent forms for HIV-related testing and disclosure that the Commissioner must develop as “standardized model” forms and removes the requirement that providers obtain prior authorization for the use of alternative consent and release forms, provided that the forms contain information consistent with the standardized model forms.

A copy of the new law is attached. If you have any questions regarding the new law, please contact Maria Woods at (212) 259-0767 or mwoods@gnyha.org.

GNYHA_HIV_Consent_Update

Written by reuben

August 30th, 2011 at 5:19 am

Posted in HIV,Needlestick

Anonymous HIV Testing

Attached find:

ANONYMOUS HIV tests:

1. Anonymous HIV results in EPIC. All anonymous patients have the same name: Stick, Needle. But different codes & time.
2. Procedure steps- as an FYI- to provide for you background
3. Narrative-as an FYI- more background.

All ED providers should add Stick, Needle to their patient list.

Note: HIV results for KNOWN Source patients for Needlestick/BBFE are accessed in EPIC the same way as other lab tests.

Please let us know if there are any difficulties in accessing rapid HIV results.
If a inservice session is appropriate, Dr Wallach & I are available.

Thank you,
Alexandra (Sandy) Derevnuk, MEd, FNP-C
Department of Infection Control
Needlestick/BBFE Coordinator
212-659-9469/ Beeper 4118
FAX 212-849-2582

HIV RESULTS:

To view anonymous HIV rapid test results in EPIC.

Reminder: all Anonymous Source patients are named Stick,Needle.
All sources have the same name, MRN, DOB, location,

but DIFFERENT DATE, TIME & anonymous CODE.

Go to Patient Lists…Go to Add Patient.

ADD: Stick,Needle to your patient list.
All providers should add Stick,Needle to your patient list in order to view rapid HIV anonymous test results.

Leave Pt name: Stick,needle on your list.

HIV ANONYMOUS TESTING: PROCEDURE:

Special Form: Stat Laboratory-ANONYMOUS TESTING NEEDLESTICK SOURCE PATIENT REQUISITION

to use in Occupational exposure situations where the source patient is unable to give HIV consent.
Each pre-printed form is used for one source patient. It has 3 special pre-printed code labels. The labels are used by the needlestick coordinator(NSC)/nursing administrator:

1. For the BBFE worksheet p.1
2. For the BBFE worksheet p.2
3. Affix to the green top blood specimen tube-for the rapid HIV test.

The NSC puts this code label on top of the specimen tube labeled with the source person’s name. The NSC knows which code is linked to the specific source patient.

The green top tube goes to the lab with the pre-printed green form with the date & time written in by NSC.

All the source patients have the same name: Stick, Needle
All the source patients have the same MRN 3592458
All the source patients have the same DOB 11/11/1900
All the source patients have the same location 444

Different anonymous code: NS ____ anony

This enables the provider of the exposed person ability to look up in EPIC one patient name: Stick, Needle. The provider does not need to know the source patient name or memorize the MRN. They only need to know source patient name: Stick, Needle.
Results also in SCC.

The ED/EHS provider will be informed of the date, time & code of the source in order to look up the rapid HIV test result.

HIV Anonymous Testing Procedure

After many months of careful planning, Mount Sinai has created a procedure for anonymous HIV testing to conform to the new HIV consent law effective September 2010. The procedure applies to the provision concerning patients who are the source of an occupational exposure and are incapable of providing consent (deceased, comatose, demented). In such instances, the patient can be tested anonymously without consent.
A Needle stick Source Patient Requisition form is now in place for the Stat Laboratory. This form contains three labels with an anonymous code; two of the labels are affixed to the Blood/Body Fluid Exposure Worksheet and the third label is affixed to the green top blood specimen tube. The anonymous test result can be seen in all systems under the name Stick, Needle. Within the name Stick, Needle, each needle stick case will have its corresponding anonymous code. Only the nursing administrator or needle stick coordinator will be aware of the patient’s real name and this will remain confidential. The code will then be provided to the ED or EHS provider in order to retrieve HIV results.

Written by reuben

July 21st, 2011 at 9:53 pm

Posted in Needlestick

HIV anonymous test procedure & results in EPIC

with one comment

Dear Carolyn & Winston,

We now have special forms: Stat Laboratory-ANONYMOUS TESTING NEEDLESTICK SOURCE PATIENT REQUISITION

to use in Occupational exposure situations where the source patient is unable to give HIV consent.
Each pre-printed form is used for one source patient. It has 3 special pre-printed code labels. The labels are used by the needlestick coordinator(NSC)/nursing administrator:

1. For the BBFE worksheet p.1
2. For the BBFE worksheet p.2
3. Affix to the green top blood specimen tube-for the rapid HIV test.

The NSC puts this code label on top of the specimen tube labeled with the source person’s name. The NSC knows which code is linked to the specific source patient.

The green top tube goes to the lab with the pre-printed green form with the date & time written in by NSC.

All the source patients have the same name: Stick, Needle
All the source patients have the same MRN 3592458
All the source patients have the same DOB 11/11/1900
All the source patients have the same location 444

Different anonymous code: NS ____ anony

This enables the provider of the exposed person ability to look up in EPIC one patient name: Stick, Needle. The provider does not need to know the source patient name or memorize the MRN. They only need to know source patient name: Stick, Needle.
Results also in SCC.

The ED/EHS provider will be informed of the date, time & code of the source in order to look up the rapid HIV test result.

We need to educate the ED staff regarding this process.
Carolyn, as the ED education link, how do we start this?

I am meeting today with Winston Charles ( at 3:30pm Friday) He is the education link with the Nursing Administrators.

Thank you,

Sandy

Alexandra (Sandy) Derevnuk, MEd, FNP-C
Department of Infection Control
Needlestick/BBFE Coordinator
212-659-9469/Beeper 4475 or 4118
FAX 212-849-2582

Written by reuben

May 13th, 2011 at 6:45 pm

Posted in Epic,Needlestick

BBFE Handout March 2011

Written by reuben

March 10th, 2011 at 11:33 pm

Posted in Needlestick

BBFE Forms

I went to the needlestick meeting yesterday and just wanted to send along a few friendly reminders.
– When a blood or body fluid exposure presents to the ED we need to fill out the BBFE (blood and body fluid exposure) forms. The forms are found under “copies” in IBEX and each portion needs to be filled out completely. This helps the needlestick coordinators during follow up with the employee. After the forms are filled out, the most important part is getting the forms to the needlestick coordinator who picks them up in the morning. There is a folder that can be found behind the discharge desk in the main ED. When you discharge the employee you can ask the BA to scan the forms into the chart and then place in the folder. What I do to ensure that the forms get there is to make 3 copies. I give one copy to the employee, give one copy to the BA to scan into the chart, and I place the final copy into the folder. Admittedly a bit obsessive, but then I know that the forms are in the correct place. It was stated that there are often instances that the ED is not filling out the forms or not completing them correctly, so I hope that this review and my suggestions help. If anyone has any questions as to where to find the forms, how to fill them out or where to place them please contact me and I would be happy to go over things with you! :)
-Also, during the meeting I was surprised to hear that butterfly needles made up 50 out of 365 BBFE last year. We use butterfly needles a lot in the ED, either for repeat labs, ABG…etc. so I just wanted to review these as well. The most important thing to do after using the butterfly needle is to disengage the needle (close the needle) prior to placing it in the sharps container. Take your time and use 2 hands to push the safety over the needle to decrease the chance of an accidental stick. Also, you MUST disengage the needle prior to placing in the sharps container because if you do not another colleague is at risk of an accidental needlestick, and nobody wants that. Also, if you notice that the sharps container is 2/3 full you can call building services to have it changed. Please let me know if you need to review the use of the butterfly needle, or have any questions regarding this issue.
Thanks so much for your attention to this email, and let me know if you have any questions or concerns.
Carolyn

I went to the needlestick meeting yesterday and just wanted to send along a few friendly reminders.

– When a blood or body fluid exposure presents to the ED we need to fill out the BBFE (blood and body fluid exposure) forms. The forms are found under “copies” in IBEX and each portion needs to be filled out completely. This helps the needlestick coordinators during follow up with the employee. After the forms are filled out, the most important part is getting the forms to the needlestick coordinator who picks them up in the morning. There is a folder that can be found behind the discharge desk in the main ED. When you discharge the employee you can ask the BA to scan the forms into the chart and then place in the folder. What I do to ensure that the forms get there is to make 3 copies. I give one copy to the employee, give one copy to the BA to scan into the chart, and I place the final copy into the folder. Admittedly a bit obsessive, but then I know that the forms are in the correct place. It was stated that there are often instances that the ED is not filling out the forms or not completing them correctly, so I hope that this review and my suggestions help. If anyone has any questions as to where to find the forms, how to fill them out or where to place them please contact me and I would be happy to go over things with you! :)

-Also, during the meeting I was surprised to hear that butterfly needles made up 50 out of 365 BBFE last year. We use butterfly needles a lot in the ED, either for repeat labs, ABG…etc. so I just wanted to review these as well. The most important thing to do after using the butterfly needle is to disengage the needle (close the needle) prior to placing it in the sharps container. Take your time and use 2 hands to push the safety over the needle to decrease the chance of an accidental stick. Also, you MUST disengage the needle prior to placing in the sharps container because if you do not another colleague is at risk of an accidental needlestick, and nobody wants that. Also, if you notice that the sharps container is 2/3 full you can call building services to have it changed. Please let me know if you need to review the use of the butterfly needle, or have any questions regarding this issue.

Thanks so much for your attention to this email, and let me know if you have any questions or concerns.

Carolyn

Written by reuben

April 13th, 2010 at 8:19 pm

Posted in Needlestick

HIV PEP

I just typed this up for myself into an e-version off a hard copy “Pharmacy Bulletin” that we received- thought some of you might find it useful as well…
-L

Adults/adolescents:
Truvada (Tenovir/Emtricitabine): 1tab po qd c or s food
Atazanavir(Reyataz) 300mg po qd c food
Ritonavir(Norvir) 100mg po qd c food

Pediatric:
Zidovudine (10mg/ml prep or 300mg tab) 220 mg/m2 bid (max 300 bid)
Lamivudine (10mg/ml prep or 150mg tab) 4mg/kg bid (max 150 bid)
Lopinavir/ritonavir (80/20 mg/ml prep, 100/25 tabs, 200/50 tabs)
2w-6m: 16mg/kg lopinavir bid
>6m and <15kg: 12 mg/kg lopinavir bid
>6m and 15-40kg: 10 mg/kg lopinivir bid
>6m and >40kg: 400mg lopinavir bid

Written by phil

April 4th, 2010 at 1:40 am

Posted in ID,Needlestick

Needlesticks During Business Hours

Just to be clear, needle stick patients who are hospital employees should be sent to employee health from 9-5 Monday thru Friday. They sometimes show up in the ED.
Adam Vella, MD

Just to be clear, needle stick patients who are hospital employees should be sent to employee health from 9-5 Monday thru Friday. They sometimes show up in the ED.

Adam Vella, MD

Written by reuben

March 25th, 2010 at 8:39 pm

Posted in Needlestick

Blood Borne Fluid Exposure Reminder

Just a reminder

1. there is BBFE (blood borne fluid exposure) information sheet in copies, and order set

2. if you have any questions after hours call the ID fellow on call

3. the nursing supervisor should take care of all of the testing of the pt on the floor, and will let you know the status of the source pt

4. if the source is hep B+, and the healthcare worker did not complete her dose or is known nonimmune  give hep b vaccine,
BUT, if the worker did not get hepatitis vaccine give immunoglobulin

5. if you give PEP the pt should followup at Jack Martin

6. make sure to fill out BBFE case summary checklist and leave it in the discharge desk. The needlestick coordinator will pick up these forms in the morning.

Employees that are stuck with a needle, or who have fluid exposure follow up at employee health.

Nonoccupational exposure pts who are given pep, ie needlestick, sexual assault or encounter follow up at jack martin.

thanks
meika

Written by reuben

April 7th, 2009 at 6:56 pm

Posted in Needlestick

HIV Test Results Access Through EDR

Good evening, just a reminder about needlestick patients – we are able to obtain the results of the rapid HIV tests done on the patient  – it is in EDR – see below for details
in EDR – put in pt name/mr

Resident Menu
Date/Time: select: ALL DATA
Format: select: SHOW DETAILS OF ALL TESTS
Select: PROTECTED  (last on the pull down menu)
Click Get Data

thank you
Meika

Written by reuben

January 17th, 2009 at 3:32 am

Posted in ID,Needlestick

Reminders about Sinai workplace needlestick

Written by reuben

January 13th, 2009 at 2:21 am

Posted in Needlestick

Needlestick Procedures

NB from Andy: all needle sticks / body fluid exposures must have a body fluid form filled out and scanned into the record.  The forms can be located under copies > MD Forms > Needlestick H&P and Needlestick Reference.

Written by phil

January 2nd, 2009 at 4:57 pm

Posted in Needlestick

HIV PEP – 2 options

with one comment

NB.There are two different packages of HIV PEP (Kaletra and Truvada) in the Pyxis—a 5 day supply and a 1 dose supply.

Use the single dose HIV PEP for needlesticks and body fluid exposures where the SOURCE

patient is known, consentable  and can have rapid HIV testing return within few hours, ie. Inpatient at Mount Sinai and patient or surrogate can give consent.

ALL other patients who have a significant exposure within the 36 hour time frame, unknown source or unavailable source—this would include sexual assault patients—should receive the 5 day starter HIV PEP and be referred to the appropriate area for follow up—EHS (employees

off for the weekend who cannot return until Monday), sexual assault survivors, etc go to Jack Martin Clinic or Adolescent Health depending upon age.

The reason for 2 different packaging methods is cost—the majority of needlesticks from inhospital known source can get rapid HIV testing (and this is usually negative and the rest of the 5 day course is wasted. If the employee is exposed to KNOWN positive patient, consider ID consult to see if this regimen is best and give 5 day course with referral to JMC.

Thanks for you attention!

Barbara Richardson

Written by reuben

November 17th, 2008 at 8:59 pm

Posted in ID,Needlestick