RESEARCH MEDICAL CENTER
Policies and Procedures
Policy # PI secretary will assign
Policy Title: Domestic Violence – Intimate Partner Violence – The Bridge Program
Replaces Policy #:Really important! Include the prior policy
Effective Date:
name or number. If it is a new policy, state new.
Will be added by PI
after approval processes are complete.
Policy Owner: Cyndi Johnson, CNO ext. 4379
Approved by: Other Committee approval obtained. For example
Date Revised: 10/15/2009;
Ethics may review Code Blue, but the Critical Care Committee owns it.)
Responsible Committee:
Type:
Hospital Wide Manual
02/17/2004; 06/30/2000
Date Retired:
Double click on the box to check.
Must be one of the 5 manuals:
1. Collaborative and Multidisciplinary Policy and Procedures;
2. Patient care Policy and Procedures;
3. Human Resources Policy and Procedures;
4. Environment of Care Policy and Procedures (includes Safety);
5. Disaster Recovery Policy and Procedures.
Department Specific
Limited to:
Radiology, Laboratory, Pharmacy, and Radiation Oncology.
It is very important that you fill out the header completely.
I. Purpose Statement: To provide a guideline to identify and assess patients
who are possible victims of abuse or neglect and treat the special needs relative to
domestic violence.
II.
Policy Title: Domestic Violence – Intimate Partner Violence
III.
Policy Owner: Cyndi Johnson
IV.
Definitions: Domestic Violence/Intimate Partner Violence (IPV): Domestic
Violence is a pattern of assaultive and coercive behaviors that can include physical
injury, the threat of physical injury, psychological abuse, sexual assault, progressive
social isolation, stalking, deprivation, intimidation, and threats. These behaviors are
perpetrated by someone who is, was, or wishes to be involved in an intimate or dating
relationship with an adult or adolescent and are aimed at establishing power and control
over the other.
The Bridge Program: The Bridge Program is a twenty-four hour a day, hospital
advocacy program for Domestic Violence/Intimate Partner Violence operated by Rose
Brooks Center. The program provides domestic violence support and resources
including shelter referrals, community resource information, orders of protection, legal
assistance, safety planning, and follow-up referrals and support. The Bridge Program
provides crisis intervention services with referrals to in-house and community resources
for ongoing assistance.
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V.
Policy: Research Medical Center will utilize a house-wide comprehensive
approach to address the needs of patients who are experiencing or have experienced
domestic violence. This comprehensive approach includes:
1. Universal Screening
2. Referral of Victims
3. Documentation
4. Training for Clinical Staff
5. Reporting requirements
6. Patient Safety Procedures
VI.
Procedure: During the process of assessing an adult who presents with an
injury, all staff interacting with the patient should evaluate the patient for signs and
symptoms of possible domestic abuse.
1. Screening
a. All patients should be screened for domestic violence regardless of their cultural
background.
b. In the case of domestic violence, “adult” is classified as age fourteen years and
older because the individual could be experiencing dating violence. If child
abuse is suspected a social work consult should be initiated.
c. Before screening for domestic violence, it is essential to create an environment of
safety and privacy. Therefore, all screening should take place apart from
patient’s partner and family, if possible.
The clinical staff completing the Department Initial Assessment forms is responsible for
screening the patient for domestic violence by asking the following questions, which are
part of the assessment
Because violence affects so many people, we at Research ask all of our
patients just a few questions about violence in their lives:
1) Are you in a situation where a family member, caretaker, current or former
partner (boyfriend, girlfriend, spouse) is calling you names, or has threatened
you in ways that make you feel uncomfortable or afraid?
2) Have you recently been hit, kicked, pushed, strangled, threatened, or
otherwise hurt by a family member, caretaker, your current or former partner
(boyfriend, girlfriend, spouse)?
3) Do you feel unsafe returning home?
 If the patient answers “yes” consult Bridge Program at 816-545-4700.
d. Referral
a. If the patient answers “yes” to questions number of the domestic violence
screening questions in the Department Initial Assessment forms the clinical
staff person performing the assessment should make an automatic referral to
the Bridge Program.
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1. The referral to the Bridge Program can be made 24-hours-a-day, 7
days-a-week by calling 816-545-4700.
Response time:
 The Bridge Advocate should call the referring individual to
confirm within 30 minutes.
 If the Bridge Advocate does not call to confirm within 30 minutes
please call the hotline (816-545-4700) back to notify them that
you have not received a confirmation call.
 A Bridge Advocate should be at the hospital within 45 minutes
and no later than 1hour after the original hotline call is made.
If you are having difficulty accessing services please call:
 Bridge Program Coordinator: Pager-816-818-5918
 Rose Brooks Shelter Office-816-861-6100. Ask for the
coordinator or the director to call hospital immediately.
2. The Bridge Program Advocate will meet with the patient to obtain
consent for Bridge Program services.
a. If the patient consents, the advocate will provide Bridge
Program services.
b. If the patient does not consent, the advocate will honor the
patient’s wishes.
3. The Bridge Program Advocate will communicate any important
information from the assessment to the referring clinical staff member.
Documentation
All relevant historical items should be recorded on the chart in descriptive rather than
judgmental terms, and using the patient’s own words whenever possible. A precise
description of the location and appearance of lesion should be recorded.
Photography may be considered, pursuant to standard hospital policy.
1. Rose Brooks has a camera stored in the safe at security dispatch center. Rose
Brooks advocate will take pictures and document photos on Rose Brooks
photography form along with chain of custody documentation form. Photos will be
kept and stored on site at Rose Brooks Center not placed in medical records.
2. Rose Brooks Advocate will document on Bridge Program Intake Form and
documentation will be stored on site and Rose Brooks Center, not in medical
records.
3. Clinical staff should document carefully the patient’s response and injuries, using
the patients own words when possible. Clinical staff should also document that a
referral was made to The Bridge Program.
Ongoing Evaluation
1. At any time during the patient’s hospitalization if the patient discloses they are in
a domestic violence situation, a consult will be initiated to the Rose Brooks
Bridge Program (see referral section).
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2. If a member of the health care team suspects the patient is a victim of domestic
violence, the health care provider will inform the patient of the Bridge Program
services and offer to make a consult.
Advisory Alerts:
Advisory Alerts are issued by government agencies; they may include recalls or changes in
policy/procedure recommended as a result of injury or injury potential. Example: JCAHO issued an advisory alert
regarding the use of PCA, “PCA by Proxy”. This is referenced in our PCA policy.
References:
1. Family Violence Prevention Fund (2004). National consensus guidelines on
identifying and responding to domestic violence victimization in health care
settings, Family Violence Prevention Fund; San Francisco (CA): Feb 1. 70 p.
Signatures:
Kevin Hicks
Chief Executive Officer
Cyndi Johnson, RN
Chief Nursing Officer
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