Abuse and Neglect Screening in the Triage Area for the Pediatric Patient

Purpose:
Identification of child abuse through patients that access the Emergency Department poses a threat through a multitude of barriers. Obstacles that may affect the diagnosis vary from the comfort level of the nurse recognition of abuse to undistinguishable signs of the child.

Relevance/Significance:
Children who experience harm secondary to child abuse are likely to be seen and treated by a healthcare provider yet detection rates still remain low. Our Emergency Department treats over 17,000 pediatric patients annually which have the potential to greatly impact undetected children. It is estimated that there is a loss of five children every day due to abuse related injuries. It is currently unclear as to how many missed cases of child abuse cases are seen in the health care setting.

Strategy and Implementation:
Through a quantitative quasi-experimental intervention control trial study with a retrospective cohort a screening tool was developed. From this study, education was brought to the staff on local prevalence, signs of detection, and case presentations. Q&A was presented to the staff which brought awareness, this awareness prompted intuition, thus alerting the nurse to detect potential child abuse cases. With the detection of potential child abuse, a nurse would then further investigate and report abuse if warranted. Stemming from this research project a initiative has begun to develop a child abuse task force that will bridge the medical field and the community service sector to improve the quality and response to children suffering from child abuse.

Evaluation:
With a post-test scoring of 97% Emergency Department nurse stated that they were more confident in reporting potential child abuse cases through the education and the screening tool. With the combination of the use of the screening tool and the education given to the nurses we found an increase in the number of abuse cases reported.

Implications for Practice:
With the implementation of the pediatric focused tool we determined that they we had the potential for missed reporting of child abuse cases. Through public awareness, evaluating hospital readiness, and working with local community agencies we hope to expand our knowledge to surrounding hospitals.