Lethality Assessment Program

Purpose:
The Maryland Network Against Domestic Violence in conjunction w/ FMH recognized the need to identify & assist victims of domestic violence and abuse. The Lethality Assessment Program (LAP) was developed to help the RN assess & inform the pateint they may become a victim of homicide.

Significance:
At FMH we are good at treating patients, but we have not always assisted victims in realizing they could be in lethal danger. The goal is to link victims of abuse w/ the domestic violence services available that can help them w/ immediate and/or long term safety plans, shelter & legal expertise.

Strategy and Implementation:
When a patient presents to the ED, the RN uses her critical thinking skills to assess the patient for domestice violence. During triage, the RN asks herself, "Is there any indication, suspicion or belief of possible abuse?" If the RN responds with a "yes", then a lethality assessment form automatically prints out from our on-line documentation record. Per protocol, the patient is taken to a private location where the primary RN sits with the patient and asks them 11 questions from the lethality tool. If a "yes" response is given to any of the first 3 questions or 4 of the remaining 7 questions, the RN phones Heartly House (the local safe house) making them aware that this is a High Danger Assessment. The patient then makes the choice of screening in with the advocate or declining their assistance at that time. All Forensic Nurse Examiners and ED RNs are trained to perform the Lethality Assessment.

Evaluation:
Since March 2010, FMH is one of 2 pilot hospitals in Maryland that has implemented the Lethality Assessment Program. As of 4th Quarter 2010, FMH has been able to screen 66 victims with 71% of them screening in at High Danger.

Implications for Practice:
Through the LAP, the RNs at FMH are completing the continuum of care (TJC PC 01.01.09) to provide our patients access to safety planning and services during a time of personal lethal danger. Between March - December 2010, 68% of screened patients spoke with an adovcate & 53% continued services.