Exposure to Blood & Body Fluids

1. Exposure to Blood & Body Fluids Entering Orders in Wiz and Nursing Follow-up

2. Employees exposed to Blood and Body Fluids during the hours of 8A to 5P should go to Occupation Health. • Employees exposed 5P to 8A and on weekends should be seen in the Adult ED. • Non Vanderbilt employees can be treated at anytime in the ED.

3. Exposure to Blood and Body Fluids is selected from the Common Clinical Problems Page.

4. When HIV status is known, select either Positive or Negative. • If HIV status is Unknown, consider all unknowns low risk unless extenuating circumstances, ie, needle, sharp in trash or bloody equipment in a room where an HIV patient was just discharged • If patient Not Vanderbilt employee or student, select Neither • If Source of exposure is known, enter name & MR # • If Source of exposure Not known, enter reason (ie, needle in laundry)

5. Exposure Type: • Major or Minor • Tetanus Needed? MD is now ready to view recommendations based on information collected and treatment Protocols.

6. MD: • explains recommendations to patient • Instructs patient that a signed Consent is needed to proceed if Post Exposure Prophylaxis (PEP) is recommended.

7. MD clicks patient’s Consent preference and Submits Order. If patient refuses PEP, MD clicks (NO), then clicks “View Recommendations” again. Recommendations include Lab tests but no Medication therapy is given when PEP refused. A consent form must also be signed if the patient refuses PEP.

8. Nursing Follow-up • Once the ordering process is complete, orders display in Orders Tracker and Lab Requisitions print for all tests EXCEPT: • HIV I antibody • Hepatitis C antibody • Hepatitis B surface antibody • Hepatitis B core antibody • The nurse is instructed to print various documents from e-Docs. • Complete employee exposure requisition for tests above(print from e-docs) • Have patient sign “Consent /Refusal for PEP for occupational blood/body fluid exposure and place in chart (Print from e-docs) • Give patient “Blood/Body Fluid Exposure: Discharge Instructions for Vanderbilt employees” (print from e-docs)

9. How to Find e-Docs • From the Wiz Patient Census Screen, Click on “Web” Button (located in lower right corner of screen). • Click e-Docs from VUMC Resources Page

10. e-Docs Type “Exposure” in Search box

11. View Search Results and Print

12. Lab Req From e-Docs for Sequestered Tests Results

13. Nursing Follow-up • Collect Specimens • Completes Wiz Requisitions • Completes e-doc Requisition for HIV and Hepatitis Tests • Administers PEP if ordered ONLY after Consent Form signed. • Gives patient educational materials from e-docs. • Instruct patient to contact Occupational Health at 936-0955 the next business day.

14. If Questions regarding Ordering and Follow-up care of Exposure patients, contact: • Dr. Ian Jones, Assistant Director Emergency Department • Dr. Melanie Swift, Director of Occupational Health Dept. • ED Nursing Management