Harbor:Non-Occupational Exposure - Revision history

Bchap23: /* Harbor ED Policy */

2025-08-13T17:16:17Z

Harbor ED Policy

← Older revision		Revision as of 17:16, 13 August 2025
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	*** Limit detailed documentation of described events to avoid future discrepancies		*** Limit detailed documentation of described events to avoid future discrepancies
	*** Closest SART Center is in San Pedro. Call sheriffs at Harbor to speak to patient, they will determine precinct in which even happened and contact that local precinct to interview patient and determine if patients meets SART criteria.		*** Closest SART Center is in San Pedro. Call sheriffs at Harbor to speak to patient, they will determine precinct in which even happened and contact that local precinct to interview patient and determine if patients meets SART criteria.
	*** Forensic Nurse Specialist (SART Staff) available 24/7 at (562) 497-0147		*** Forensic Nurse Specialist (SART Staff) available 24/7 at (562) 497-0147; alt 562-430-6220
	**** Los Angeles SART Centers: https://www.wikem.org/wiki/File:SART_Centers.pdf		**** Los Angeles SART Centers: https://www.wikem.org/wiki/File:SART_Centers.pdf
	**** OLD Resource of SART list https://emedharbor.labiomed.org/private/Contact%20Info/ED%20Documents/Sexual%20Assault%20Protocol.pdf		**** OLD Resource of SART list https://emedharbor.labiomed.org/private/Contact%20Info/ED%20Documents/Sexual%20Assault%20Protocol.pdf

Bchap23 at 00:41, 2 January 2023

2023-01-02T00:41:09Z

← Older revision		Revision as of 00:41, 2 January 2023
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	*Psych or disabled patients complicated, work with SART staff/SW		*Psych or disabled patients complicated, work with SART staff/SW
	*Forensic Nurse Specialist (SART Staff) available 24/7 at (562) 497-0147 if any questions/issues		*Forensic Nurse Specialist (SART Staff) available 24/7 at (562) 497-0147 if any questions/issues
	*Draw labs and STI testing in ED		* Use the '''ED Sexual Assault''' or '''ED PED Sexual Assault''' order sets
			**Draw labs and STI testing in ED
	**HIV Antibody/Antigen Screen, Hepatitis B Surface Antigen, Hepatitis C Viral Load-PHL, RPR, Pregnancy test, Urine Chlamydia/Neisseria gonorrhoeae RNA, TMA		**HIV Antibody/Antigen Screen, Hepatitis B Surface Antigen, Hepatitis C Viral Load-PHL, RPR, Pregnancy test, Urine Chlamydia/Neisseria gonorrhoeae RNA, TMA
	**If being consented for HIV PEP, then also need CBC w/ Diff, BMP, LFT		**If being consented for HIV PEP, then also need CBC w/ Diff, BMP, LFT

Bchap23: /* General Guidelines for Harbor-UCLA ED */

2022-03-03T15:21:59Z

General Guidelines for Harbor-UCLA ED

← Older revision		Revision as of 15:21, 3 March 2022
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	*Forensic Nurse Specialist (SART Staff) available 24/7 at (562) 497-0147 if any questions/issues		*Forensic Nurse Specialist (SART Staff) available 24/7 at (562) 497-0147 if any questions/issues
	*Draw labs and STI testing in ED		*Draw labs and STI testing in ED
	**HIV Antibody/Antigen Screen, Hepatitis B Surface Antigen, ~~sHepatitis~~ C Viral Load-PHL, RPR, Pregnancy test, Urine Chlamydia/Neisseria gonorrhoeae RNA, TMA		**HIV Antibody/Antigen Screen, Hepatitis B Surface Antigen, Hepatitis C Viral Load-PHL, RPR, Pregnancy test, Urine Chlamydia/Neisseria gonorrhoeae RNA, TMA
	**If being consented for HIV PEP, then also need CBC w/ Diff, BMP, LFT		**If being consented for HIV PEP, then also need CBC w/ Diff, BMP, LFT
	**CCC for lab f/u and NERF through Cerner to bridge to PCP if DHS and doesn't have a PCP. If already empaneled, message PCP.		**CCC for lab f/u and NERF through Cerner to bridge to PCP if DHS and doesn't have a PCP. If already empaneled, message PCP.
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	*Consider STI prophylaxis, Plan B, Hep B and HPV vaccines, PEP prophylaxis within 72 hours		*Consider STI prophylaxis, Plan B, Hep B and HPV vaccines, PEP prophylaxis within 72 hours
	**Empiric antibiotic therapy		**Empiric antibiotic therapy
	***cefTRIAXone ~~250~~ mg, IM		***cefTRIAXone 500 mg, IM
	****cefTRIAXone 50 mg/kg, IM, Maximum dose ~~250~~ mg		****cefTRIAXone 50 mg/kg, IM, Maximum dose 500 mg
	***azithromycin 1,000 mg, Oral		***azithromycin 1,000 mg, Oral
	****Pediatric dose: azithromycin 20 mg/kg, Oral, For patients who weigh < 45 kg. Maximum dose 1,000 mg per dose.		****Pediatric dose: azithromycin 20 mg/kg, Oral, For patients who weigh < 45 kg. Maximum dose 1,000 mg per dose.

Andreawu at 05:36, 15 December 2021

2021-12-15T05:36:53Z

← Older revision		Revision as of 05:36, 15 December 2021
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	****Ped dose: metroNIDAZOLE (metroNIDAZOLE 100 mg/mL oral suspension) 15 mg/kg, Oral, TID, X 7 days, mL, 0 Refill(s) For patients who weigh < 45 kg. Maximum dose 666.67 mg/dose or 2,000 mg/day		****Ped dose: metroNIDAZOLE (metroNIDAZOLE 100 mg/mL oral suspension) 15 mg/kg, Oral, TID, X 7 days, mL, 0 Refill(s) For patients who weigh < 45 kg. Maximum dose 666.67 mg/dose or 2,000 mg/day
	**Emergency contraceptives		**Emergency contraceptives
	***~~levonorgestrel 1.5~~ mg, Oral, Form: Tab, ONCE, STAT		***ulipristal 30 mg, Oral, Form: Tab, ONCE, STAT
	* HIV post-exposure prophylaxis (PEP) guidelines		* HIV post-exposure prophylaxis (PEP) guidelines
	**Do not have to call HIV consult, per Drs. Witt and Wu, unless usual circumstance (e.g. disabled patient unable to swallow pills)		**Do not have to call HIV consult, per Drs. Witt and Wu, unless usual circumstance (e.g. disabled patient unable to swallow pills)

Andreawu at 04:28, 15 December 2021

2021-12-15T04:28:13Z

← Older revision		Revision as of 04:28, 15 December 2021
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	*** lamiVUDine 4 mg/kg, Liquid, Indication: HIV/PREP patients younger than 12 years or less than 35 kg for HIV post-exposure prophylaxis per CDC guidelines. Maximum dose 150 mg.		*** lamiVUDine 4 mg/kg, Liquid, Indication: HIV/PREP patients younger than 12 years or less than 35 kg for HIV post-exposure prophylaxis per CDC guidelines. Maximum dose 150 mg.
	***lopinavir-ritonavir (lopinavir-ritonavir 400 mg-100 mg/5 mL) Liquid, Indication: HIV/PREP Restricted to patients for HIV post-exposure prophylaxis per CDC guidelines. Target Dose: < 15 kg give 12 mg-3 mg/dose PO BID (0.15 mL/kg/dose); >= 15 kg give 10 mg-2.5 mg/dose PO BID (0.125 mL/kg/dose). Maximum dose 400 mg-100 mg per dose.		***lopinavir-ritonavir (lopinavir-ritonavir 400 mg-100 mg/5 mL) Liquid, Indication: HIV/PREP Restricted to patients for HIV post-exposure prophylaxis per CDC guidelines. Target Dose: < 15 kg give 12 mg-3 mg/dose PO BID (0.15 mL/kg/dose); >= 15 kg give 10 mg-2.5 mg/dose PO BID (0.125 mL/kg/dose). Maximum dose 400 mg-100 mg per dose.
	**Need a 2 week prescription and follow up with PEP clinic in 2 weeks for a lab check. Total 4		**Need a 2 week prescription and follow up with PEP clinic in 2 weeks for a lab check. Total 4 week course. If afterhours, give 48hr to go pack and 12d rx. OOP patients go to Bella Vida Pharmacy across the street. If peds patient, pharmacy to bring 14d supply bring to bedside.
	week course.
	**Vaccines		**Vaccines
	*** Tdap		*** Tdap
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	**Give patient copy of labs		**Give patient copy of labs
	**If giving HIV PEP, call ED pharmacist to bring HIV PEP to bedside		**If giving HIV PEP, call ED pharmacist to bring HIV PEP to bedside
	***give adult patient limited 48 hour supply of PEP to go and also Rx		***If outpatient pharmacy is closed, then give adult patient limited 48 hour supply of PEP to go and also Rx for 12d supply
	***~~give~~ pediatric patient full 2 week supply to go		***If pediatric patient, then give full 2 week supply to go
	**For Rx, give 2 week supply		**For Rx, give 2 week supply
	***If patient is DHS eligible, send Rx to our pharmacy		***If patient is DHS eligible, send Rx to our pharmacy

Andreawu: /* General Guidelines for Harbor-UCLA ED */

2020-10-27T23:03:16Z

General Guidelines for Harbor-UCLA ED

← Older revision		Revision as of 23:03, 27 October 2020
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	**Emergency contraceptives		**Emergency contraceptives
	***levonorgestrel 1.5 mg, Oral, Form: Tab, ONCE, STAT		***levonorgestrel 1.5 mg, Oral, Form: Tab, ONCE, STAT
	** HIV post-exposure prophylaxis (PEP) guidelines		* HIV post-exposure prophylaxis (PEP) guidelines
	***Do not have to call HIV consult, per Drs. Witt and Wu, unless usual circumstance (e.g. disabled patient unable to swallow pills)		**Do not have to call HIV consult, per Drs. Witt and Wu, unless usual circumstance (e.g. disabled patient unable to swallow pills)
	***Per CDC and LAC DHS best practice: only recommended if <= 72 hours since exposure ~~and~~		**Per CDC and LAC DHS best practice: only recommended if <= 72 hours since exposure AND
	**assailant HIV positive		***assailant HIV positive
	**assailant HIV status unknown, but patient’s mucous membranes or non-intact skin exposed to		***assailant HIV status unknown, but patient’s mucous membranes or non-intact skin exposed to
	***blood, semen, vaginal secretions, or bloody body fluids		****blood, semen, vaginal secretions, or bloody body fluids
	**Adult dosing:		**Adult dosing:
	***emtricitabine-tenofovir (Truvada) 1 tabs, Oral, Indication: HIV/PREP Restricted to HIV post-exposure prophylaxis per CDC guidelines		***emtricitabine-tenofovir (Truvada) 1 tabs, Oral, Indication: HIV/PREP Restricted to HIV post-exposure prophylaxis per CDC guidelines

Andreawu: /* General Guidelines for Harbor-UCLA ED */

2020-10-26T23:00:50Z

General Guidelines for Harbor-UCLA ED

← Older revision		Revision as of 23:00, 26 October 2020
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	**HIV Antibody/Antigen Screen, Hepatitis B Surface Antigen, sHepatitis C Viral Load-PHL, RPR, Pregnancy test, Urine Chlamydia/Neisseria gonorrhoeae RNA, TMA		**HIV Antibody/Antigen Screen, Hepatitis B Surface Antigen, sHepatitis C Viral Load-PHL, RPR, Pregnancy test, Urine Chlamydia/Neisseria gonorrhoeae RNA, TMA
	**If being consented for HIV PEP, then also need CBC w/ Diff, BMP, LFT		**If being consented for HIV PEP, then also need CBC w/ Diff, BMP, LFT
	**CCC for lab f/u and bridge to PCP if DHS and doesn't have a PCP		**CCC for lab f/u and NERF through Cerner to bridge to PCP if DHS and doesn't have a PCP. If already empaneled, message PCP.
	**Outside HIV clinics or OOP network PCP		**Outside HIV clinics or OOP network PCP
	**Pediatric patients can utilize HUB clinic for f/u		**Pediatric patients can utilize HUB clinic for f/u

Andreawu: /* General Guidelines */

2020-10-26T19:03:40Z

General Guidelines

← Older revision		Revision as of 19:03, 26 October 2020
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	==General Guidelines==		==General Guidelines for Harbor-UCLA ED==
	*SART candidate if within 96 hours (5d), authorized by law enforcement		*SART candidate if within 96 hours (5d), authorized by law enforcement
	*Call LASD to report and find out what PD precinct needs to come take report and approve SART exam		*Call LASD to report and find out what PD precinct needs to come take report and approve SART exam
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	**Empiric antibiotic therapy		**Empiric antibiotic therapy
	***cefTRIAXone 250 mg, IM		***cefTRIAXone 250 mg, IM
			****cefTRIAXone 50 mg/kg, IM, Maximum dose 250 mg
	***azithromycin 1,000 mg, Oral		***azithromycin 1,000 mg, Oral
			****Pediatric dose: azithromycin 20 mg/kg, Oral, For patients who weigh < 45 kg. Maximum dose 1,000 mg per dose.
	***metroNIDAZOLE 2,000 mg, Oral		***metroNIDAZOLE 2,000 mg, Oral
			****Ped dose: metroNIDAZOLE (metroNIDAZOLE 100 mg/mL oral suspension) 15 mg/kg, Oral, TID, X 7 days, mL, 0 Refill(s) For patients who weigh < 45 kg. Maximum dose 666.67 mg/dose or 2,000 mg/day
	**Emergency contraceptives		**Emergency contraceptives
	***levonorgestrel 1.5 mg, Oral, Form: Tab, ONCE, STAT		***levonorgestrel 1.5 mg, Oral, Form: Tab, ONCE, STAT
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	***raltegravir 400 mg, Oral, Indication: HIV/PREP Restricted to HIV post-exposure prophylaxis per CDC guidelines		***raltegravir 400 mg, Oral, Indication: HIV/PREP Restricted to HIV post-exposure prophylaxis per CDC guidelines
	** Pediatric dosing: liquid formulations can only be given by our pharmacy. Call ED pharmacist to bring 2 week supply to bedside for patient.		** Pediatric dosing: liquid formulations can only be given by our pharmacy. Call ED pharmacist to bring 2 week supply to bedside for patient.
	***		*** zidovudine Liquid, Indication: HIV/PREP Restricted to patients for HIV post-exposure prophylaxis per CDC guidelines. Target Dose: 4 to 9 kg give 12 mg/kg/dose PO BID; 9 to 30 kg give 9 mg/kg/dose PO BID; >= 30 kg give 300 mg/dose PO BID
			*** lamiVUDine 4 mg/kg, Liquid, Indication: HIV/PREP patients younger than 12 years or less than 35 kg for HIV post-exposure prophylaxis per CDC guidelines. Maximum dose 150 mg.
			***lopinavir-ritonavir (lopinavir-ritonavir 400 mg-100 mg/5 mL) Liquid, Indication: HIV/PREP Restricted to patients for HIV post-exposure prophylaxis per CDC guidelines. Target Dose: < 15 kg give 12 mg-3 mg/dose PO BID (0.15 mL/kg/dose); >= 15 kg give 10 mg-2.5 mg/dose PO BID (0.125 mL/kg/dose). Maximum dose 400 mg-100 mg per dose.
	**Need a 2 week prescription and follow up with PEP clinic in 2 weeks for a lab check. Total 4		**Need a 2 week prescription and follow up with PEP clinic in 2 weeks for a lab check. Total 4
	week course.		week course.
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	*Discharging		*Discharging
	**Give patient copy of labs		**Give patient copy of labs
	**If giving HIV PEP, call ED pharmacist to give limited 48 hour supply of PEP to go and also Rx		**If giving HIV PEP, call ED pharmacist to bring HIV PEP to bedside
			***give adult patient limited 48 hour supply of PEP to go and also Rx
			***give pediatric patient full 2 week supply to go
	**For Rx, give 2 week supply		**For Rx, give 2 week supply
	***If patient is DHS eligible, send Rx to our pharmacy		***If patient is DHS eligible, send Rx to our pharmacy
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	***If pediatric patient, our pharmacy will bring full supply to bedside		***If pediatric patient, our pharmacy will bring full supply to bedside
	**Provide patients with the PEP discharge instructions (includes clinic list) so they may find clinic for follow up.		**Provide patients with the PEP discharge instructions (includes clinic list) so they may find clinic for follow up.
			**Pediatric patients follow up in SCAN and HUB clinics
	**Transportation issues - talk to SW and law enforcement		**Transportation issues - talk to SW and law enforcement
	***Law enforcement usually transports to SART		***Law enforcement usually transports to SART
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	**Case by case basis can come to hospital for exam		**Case by case basis can come to hospital for exam
	**Prefer that patient's go there for 4 hour exam and evidence collection		**Prefer that patient's go there for 4 hour exam and evidence collection


	*Stats on Risk: https://www.wikem.org/wiki/HIV_post-exposure_prophylaxis		*Stats on Risk: https://www.wikem.org/wiki/HIV_post-exposure_prophylaxis

Andreawu: /* General Guidelines */

2020-10-26T18:50:18Z

General Guidelines

@@ Line 17: / Line 17: @@
 **Pediatric patients can utilize HUB clinic for f/u
 *Consider STI prophylaxis, Plan B, Hep B and HPV vaccines, PEP prophylaxis within 72 hours
 *Preserve evidence
 **external GU exams only check for hemorrhage
@@ Line 27: / Line 57: @@
 *Discharging
 **Give patient copy of labs
-**Can give limited 48 hour supply of PEP to go and also Rx (call ED pharmacist)
+**If giving HIV PEP, call ED pharmacist to give limited 48 hour supply of PEP to go and also Rx
-**If patient is DHS eligible, send Rx to our pharmacy
+**For Rx, give 2 week supply
-**If patient is OOP, send Rx to Bella Vida Pharmacy (across the street)
+***If patient is DHS eligible, send Rx to our pharmacy
-**If pediatric patient, our pharmacy will bring full supply to bedside
+***If patient is OOP, send Rx to Bella Vida Pharmacy (across the street)
 **Transportation issues - talk to SW and law enforcement
 ***Law enforcement usually transports to SART

Andreawu: /* General Guidelines */

2020-10-26T18:38:54Z

General Guidelines

← Older revision		Revision as of 18:38, 26 October 2020
Line 1:		Line 1:
	==General Guidelines==		==General Guidelines==
	*SART candidate if within 96 hours (5d), authorized by law enforcement		*SART candidate if within 96 hours (5d), authorized by law enforcement
	*Call LASD to report and find out what PD precinct needs to come take report		*Call LASD to report and find out what PD precinct needs to come take report and approve SART exam
	*LASD is your liaison to interact with outside law enforcement		*LASD is your liaison to interact with outside law enforcement, call if issues with timeliness
	*Call social work consult		*Call social work consult, can help with support and resources
			*Consult to Violence Intervention Team
	*Consult SCAN if patient 17yo and younger		*Consult SCAN if patient 17yo and younger
	**12yo or older can consent to exam, otherwise parent/guardian consents		**12yo or older can consent to exam, otherwise parent/guardian consents
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	*Forensic Nurse Specialist (SART Staff) available 24/7 at (562) 497-0147 if any questions/issues		*Forensic Nurse Specialist (SART Staff) available 24/7 at (562) 497-0147 if any questions/issues
	*Draw labs and STI testing in ED		*Draw labs and STI testing in ED
			**HIV Antibody/Antigen Screen, Hepatitis B Surface Antigen, sHepatitis C Viral Load-PHL, RPR, Pregnancy test, Urine Chlamydia/Neisseria gonorrhoeae RNA, TMA
			**If being consented for HIV PEP, then also need CBC w/ Diff, BMP, LFT
	**CCC for lab f/u and bridge to PCP if DHS and doesn't have a PCP		**CCC for lab f/u and bridge to PCP if DHS and doesn't have a PCP
	**Outside HIV clinics or OOP network PCP		**Outside HIV clinics or OOP network PCP
	**Pediatric patients can utilize HUB clinic for f/u		**Pediatric patients can utilize HUB clinic for f/u
	*Consider STI prophylaxis, Plan B, Hep B and HPV vaccines, PEP prophylaxis within 72 hours		*Consider STI prophylaxis, Plan B, Hep B and HPV vaccines, PEP prophylaxis within 72 hours
	**~~Can give limited supply of PEP to go and also Rx (call ED pharmacist)~~		*Preserve evidence
	*~~Preserve evidence -~~ external GU exams only ~~heck~~ for hemorrhage, obtain dirty catch UA, NPO if oral trauma~~, clothes in brown paper bag (not plastic which can degrade~~ DNA~~, promote bacterial contamination), patient shouldn't wash up, document patient history in quotes~~		**external GU exams only check for hemorrhage
	**If patient already ate/drank, then doesn't need to be NPO		**obtain dirty catch UA, NPO if oral trauma with possible DNA evidence
	**If patient is NPO, give Rx for oral medications to take later after SART		***If patient already ate/drank, then doesn't need to be NPO
			***If patient is NPO, give Rx for oral medications to take later after SART
			**clothes in brown paper bag (not plastic which can degrade DNA, promote bacterial contamination),
			**patient shouldn't wash up,
			**document patient history in quotes
	*Discharging		*Discharging
	**Give patient copy of labs		**Give patient copy of labs
			**Can give limited 48 hour supply of PEP to go and also Rx (call ED pharmacist)
			**If patient is DHS eligible, send Rx to our pharmacy
			**If patient is OOP, send Rx to Bella Vida Pharmacy (across the street)
			**If pediatric patient, our pharmacy will bring full supply to bedside
	**Transportation issues - talk to SW and law enforcement		**Transportation issues - talk to SW and law enforcement
	***Law enforcement usually transports to SART		***Law enforcement usually transports to SART