An Evidence-Based Educational Intervention to Improve the Recognition and Photo Documentation of Child Abuse Injuries in a Rural Health Facility

POSTER

An Evidence-Based Educational Intervention to Improve the Recognition and Photo Documentation of Child Abuse Injuries in a Rural Health Facility Tami Byrd, BSN, RN, DNP-FNP Student Julie Balk DNP, APRN, FNP-BC, CNE; Amanda Al-Khudairi DNP, APRN, WHNP-C; Antoinette Laskey, MD, MPH, MBA; Corey Rood, MD, BS Key Findings This educational intervention resulted in an increase in staff familiarity with recognizing injuries resulting from maltreatment, increased comfort in the process of reporting suspected maltreatment within their state, and an overall increase in clinical staff knowledge of maltreatment injuries, and their mechanisms. This intervention was successful in showing that education is of key importance in increasing staff awareness of abuse in the clinical setting. Background Recognition and Photo Documentation of Child Abuse • Child maltreatment is a reality facing millions of children in our country every year • In 2015, CPS agencies in the US received ~4 million referrals, involving ~7.2 million children; 58.2% of these cases confirmed7 • Risk factors associated with child maltreatment include drug & alcohol abuse, poverty, mental health issues, living in a rural community and combat experience among military members3,4,5,6 • Besides physical injuries, emotional consequences include post-traumatic stress disorder, aggression, depression and suicidal ideation1 • Early recognition of suspicious sentinel injuries by healthcare providers allows for intervention, treatment and protection from future escalation of abusive injuries2 Remember: If they don’t cruise… they rarely bruise! Required Reporting According to Wyoming law, every person who has a reasonable suspicion that a child has been or is being abused or neglected is required to report suspicions to child protective services or local law enforcement! Questions to Ask About Injuries • Does the history match the injury? • Is the history vague, or does the story change? • Could the injury be accidental? • Was there a delay in seeking care? • Have there been repeated emergency department visits? • Is there a history of a medical condition that may mimic abuse? • Was the injury witnessed? Bruises CANNOT be accurately dated! Injury Red Flags • Changing story • Young child; under 5 years • Burn injury with a pattern • Delay in seeking care for the child • The presence of other suspicious injuries • A burn injury that covers a large surface area • Increased severity of burn injury • Bruising in protected areas • Bruising in children less than 9 months • Patterned bruising • Multiple fractures or areas of bruising • History does not explain the injury Employee reports suspected child maltreatment by Notification of: Good injury photographs provide key evidence in child abuse cases Orienting Photo Photo of Injury Skeletal survey should be performed in all children under the age of 2 years when there is a concern for abusive injuries Injury with Scale • Department of Family Services [phone] • Police jurisdiction of incident: Rock Springs Police (307)-352-1575 Green River Police (307)-872-0555 Sweetwater County Sheriff (307)-922-5300 • Supervisor, charge nurse or nursing supervisor Always consider medical mimics! Everyone is responsible for protecting our children! Results • 34 participants took part in the pre-education assessment 16 participants attended child maltreatment education sessions 11 participants took part in the post-education assessment • Following education there was a significant improvement in participants’ comfort in their ability to recognize child physical maltreatment (p=0.02) and knowledge of the Wyoming state abuse and neglect reporting hotline (p= 0.18) • Prior to education, many participants listed one or more barriers to reporting suspected maltreatment; following education, barriers were significantly reduced • There was an increase in overall score on the knowledge based questions by ~2.5 points following education sessions Methods Conclusions • This quality improvement project was developed with a goal of improving identification and photo documentation of child maltreatment injuries • A pre-education assessment was conducted • Education was developed with the aim of closing the gap between current care and national standards • Education implementation occurred at a small, rural healthcare facility in Sweetwater County, Wyoming • Education occurred in 5 one-hour sessions over a twoday period • Follow-up assessment was conducted 4 weeks after education to determine the effectiveness of teaching • Educational interventions are an effective way to increase clinical staff knowledge and comfort in recognizing and photo documenting child maltreatment injuries • Based on feedback, the information presented was relevant to all and will be useful in improving the ability to recognize injuries resulting from maltreatment • Long term implications include the prevention of negative physical and emotional consequences related to maltreatment Help create • Results show there is potential for great a world success with implementation of this educational without intervention in areas at increased risk of abuse child abuse such as military health facilities, and areas with high rates of poverty and substance abuse COLLEGE OF NURSING