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Abstract
Background Kent community health NHS Trust provides sexual health services (SHS) in East Kent serving an approximate population of 750 000 based in eight clinical sites. SHS see a significant number of sexual assault (SA) case referrals in this region as there is no designated Sexual Assault Referral Centre.
Aim This audit was conducted to determine if the management of SA cases in the services is in accordance to the standards outlined by British Sexual Health and HIV(BASHH) SA auditable outcome measures.
Method Case notes coded as SA based on a local code audited from the period of October 2010 to October 2011. Data were collected from the local SA proforma and case note documentation which identified information regarding victim's and assailant's profile and documentation of essential historical elements of SA. Other auditable outcomes measured included injury documentation, HIV risk assessment and post exposure prophylaxis (PEP) offer, police referral for crime and forensic examination (FME), self harm and child protection assessment. Data regarding emergency contraception, prophylactic antibiotics and hepatitis vaccination offered, testing for STIs and referral to EKRL were also collected.
| Total no SA codes | 92:7 notes missing: total 85 cases |
| Source of referrals | Self: 59 (69.4%) Other: 26 (30.6%) |
| Time since SA | 54 (63.5%) seen within 6 weeks |
| Assailant details | Known: 51 (60.0%) Unknown: 34 (40.0%) |
| HIV risk assessment: 100% | |
| Vaginal: 68 (81.9%) N=83 | |
| Oral: 11 (12.9%) N=85 | |
| Anal: 13 (15.3%) N=85 | |
| High risk: 13—2 eligible for PEP. Offered but declined | |
| Referral for FME | Yes 19 (22.3%) No 66 (77.7%) 10 (11.7%) had FME prior attendance |
| Referral to A and E | None |
| Emergency contraception | Yes 6 (7.0%) No 79 (93.0%) |
| Prophylaxis antibiotics for STDs | Yes 6 (7.0%) No 79 (93.0%) |
| Hepatitis B vaccination | 59 (69.4%) indicated 43 (72.9%) vaccinated |
| First visit test | Yes 64 (75.3%) No 21 (24.7%) |
| Repeat test | Yes 33 (38.8%) No 52 (61.2%) |
| Child protection assessment under 16 | 18 (94.7%) N=19 |
| Referral to police | 55 (64.7%) offered 5 (0.09%) declined |
| Referral to EKR line | Yes 48 (56.4%) No 37 (43.6%) |
| Follow-ups offered | 59 (69.4%) |
| Total follow-ups seen | 40 (47.0%) |
Conclusions This audit highlighted the importance of clear documentation of treatment and care offered and provided to victims of SA. Poor documentation of management is likely to underestimate the overall outcome of care offered, but when a treatment is indicated and initiated there is a good clear documentation. The local SA proforma is concise and user friendly for any trained and qualified healthcare individuals and covers all aspects of care as recommended by BASHH except for the self harm assessment which will be included upon revision. A close working partnership with local police, SHS and EKRL is essential to ensure the management of SA within the community is in accordance with national standards.