Evidence collection kits. Documentation. Police reports. Photographs. Trauma-responsive care. STI prophylaxis medication. Department of Justice guidelines.
Rhiannon Zerbe, BSN, RN, SANE-A, SANE-P, discussed the value of a teleSANE program to help bedside nurses treat sexual assault patients.
There’s much to consider when a sexual assault patient arrives at the emergency department. But ED nurses without specialized training or certification might be confused and overwhelmed, making unintentional mistakes when caring for these patients.
“That’s because there are a lot of little, tiny aspects that you just don’t think of,” said Rhiannon Zerbe, BSN, RN, SANE-A, SANE-P, an emergency nurse and teleSANE consultant at the University of Arkansas for Medical Sciences . “They don’t teach this in nursing school.”
That’s why some hospitals are using telemedicine to link sexual assault nurse examiner-certified nurses with bedside nurses to guide them through these exams in real time.
“A lot of hospitals throughout Arkansas use UAMS telestroke and other telemedicine programs, so this is just another area of specialized care that the patients can expect,” Zerbe said.
Zerbe discussed the value of teleSANE during her session, “TeleSANE: Improving Emergency Clinicians’ Ability to Provide Evidence-Based, Patient-Centered Sexual Assault Care.”
Even the most seasoned ED nurses might struggle with sexual assault cases because they encounter them infrequently. That’s where the SANE comes in.
“We’re in the perfect position to care for them medically and then collect that forensic evidence that’s needed if the patient agrees to that,” Zerbe said. “If you really think about SANEs, we’re kind of the bridge between the medical system and the criminal justice system.”
Despite being that critical bridge, Zerbe often sees gaps in care when these exams are performed by those without specialized training. For instance, some clinicians believe they don’t need to collect evidence more than 72 hours after the assault. However, DOJ guidelines advise 120 hours, and it can be longer with solid rationale and documentation.
Other common gaps include incomplete evidence collection, not offering HIV postexposure prophylaxis drugs when indicated, not assessing for strangulation or smothering, only sending toxicology to the hospital lab instead of the crime lab, and not fully assessing the genitals.
For hospitals without SANE nurses on staff, a teleSANE program can help ensure steps like these are covered, all documentation is completed correctly, and the chain of custody for evidence is properly maintained.
Through the teleSANE program at UAMS where Zerbe works, consultants respond to calls within 15 minutes and can appear on screen in exam rooms to guide clinicians through exams, documentation and other important steps. The consultants, who are located around the country, provide the level of guidance needed, depending on the bedside nurse’s level of experience.
“I’ve walked new grads through this and they were very successful,” Zerbe said.
Rhiannon Zerbe, BSN, RN, SANE-A, SANE-P, shared with attendees how hospitals are using telemedicine to link sexual assault nurse examiner-certified nurses with bedside nurses to guide them in caring for sexual assault patients in real time.
In addition to providing guidance during exams, teleSANE can also provide preceptor services.
“The lack of experienced SANE preceptors poses a significant barrier for nurses working towards eligibility criteria to take the SANE-A certification exam,” Zerbe said later via email. “The difficulty in accessing a preceptor is particularly pronounced in rural areas throughout the U.S.”
Those preceptor services were of particular interest to session attendee Mindi Wheat, ADN, RN, SANE, the ED and ICU educator and SANE program director for Christus St. Michael Health System in Oklahoma.
“I’m just very excited that there’s another option for the rural hospitals,” Wheat said.
While challenges like funding exist, surveys show that patients and clinicians are comfortable with teleSANE services and find them helpful, according to Zerbe.
“Patients are actually very happy with the collaborative care provided,” Zerbe said. “And it does increase access to specialized SANE care.”