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Improving HIV post-exposure prophylaxis rates after pediatric acute sexual assault.

Improving HIV post-exposure prophylaxis rates after pediatric acute sexual assault.
Author Information (click to view)

Schilling S, Deutsch SA, Gieseker R, Molnar J, Lavelle JM, Scribano PV,


Schilling S, Deutsch SA, Gieseker R, Molnar J, Lavelle JM, Scribano PV, (click to view)

Schilling S, Deutsch SA, Gieseker R, Molnar J, Lavelle JM, Scribano PV,

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Child abuse & neglect 2017 04 2669() 106-115 pii 10.1016/j.chiabu.2017.04.014

Abstract

The purpose of our study was to increase the rate of children with appropriate HIV-PEP regimens among those diagnosed with sexual assault in The Children’s Hospital of Philadelphia Emergency Department (ED). The outcome measure was the percent of patients receiving correct HIV-PEP. We retrospectively reviewed 97 charts over 31 months to define the baseline rate of children receiving appropriate HIV-PEP regimens (pre QI-implementation period: 2/2012-8/2014). Among children in which HIV-PEP was indicated following sexual assault, 40% received the recommended 28-day course. Root cause analysis indicated prescribing errors accounted for 87% of patients not receiving appropriate HIV-PEP. Process drivers included standardizing care coordination follow-up calls to elicit specific information about HIV-PEP, ED educational initiatives targeted at HIV-PEP prescribing, revision of the clinical pathway to specify indicated duration of HIV-PEP, and revision of the order set to auto-populate the number of days for the HIV-PEP prescription. During the QI-implementation period (9/2014-4/2015), the rate of appropriate HIV-PEP increased to 64% (median 60%) and the average number of days between incorrect HIV-PEP regimens was 24.5. Post QI-implementation (5/2015-3/2016), the rate of appropriate HIV-PEP increased to 84% (median 100%) and the average number of days between incorrect HIV-PEP regimens increased to 78.4. A multifaceted quality improvement process improved the rate of receipt of appropriate HIV-PEP regimens for pediatric victims of sexual assault. Decision support tools are instrumental in sustaining ideal care delivery, but require ongoing evaluation and improvement in order to remain optimally effective.

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