The Abuse Assessment (The Abuse Screen) protocol aims to detect abuse in pregnant women and refer them to a counselor, and also to increase documentation of abuse in medical records.
The Abuse Screen is a multiple-item questionnaire that asks about past and current emotional, sexual, and physical abuse, both prior to and during pregnancy. The questions assess the severity and frequency of injury and abuse. The form is included in all medical charts prepared for new prenatal care patients at their first visit to a clinic or emergency room.
The form is completed during the initial intake interview and usually is conducted by the clinic or a triage nurse. But it also could be conducted by other nurses, physicians, nutritionists, counselors, or clerical staff. Any referrals of abuse are given to an onsite counselor for further assessment and follow-up.
18 to 36
Wiist and McFarlane (1999) found that before implementation of The Abuse Assessment (The Abuse Screen) protocol no specific form to detect abuse was used in maternity medical records. After implementation, however, 88 percent of maternity medical records contained The Abuse Screen. After 12 months, the number of medical records that had the form decreased, nonsignificantly, to 85 percent. Of the forms included, 96 percent were completed and all were completed during the initial visit.
Abuse Detection and Reporting
Before the protocol was implemented, there were three instances of abuse reported in medical records at the intervention clinics and one in the control clinic. Once implemented, intervention clinics had a significantly higher rate of abuse reporting than the comparison (7 percent versus 0 percent). The number of women identified as abused at the intervention clinics was proportionately higher than that of the comparison location (7.22 percent versus 0.83 percent). According to an odds ratio, women were 6.78 times as likely to be identified as abused after implementing the protocol (confidence interval=2.34, 19.56).
Referrals for Abuse
Before implementation, there were no documented referrals in the medical records at any of the clinics for women identified as abused. At 3 months postimplementation, referrals were included in 67 percent of records. At 12 months, referrals were included in 53 percent of records.