Use of a protocol to improve exam standardization and clinical support for SANE practitioners in Montana

Abstract

Statement of Problem: Sexual assault is a common occurrence throughout the United States with significant side effects. Reporting shows that one in every six women, one out of thirty- three men, one in nine girls, and one in 20 boys are victims of sexual assault. These rates are greater among Native Americans, incarcerated individuals, military members, and those who identify as LGBTQ+IA. Side effects are many and include physical, psychological, and financial repercussions. Research suggests that sexual assault nurse examiners (SANEs) improve not only the judicial outcomes but improve patient's sense of well-being and reduce secondary traumatization. A needs survey administered to a Southeast Montana hospital SANE program indicated provider confusion when training to do the SANE exam due to a lack of standardization among how providers completed the exam. Methods: A needs survey administered to a Southeast Montana hospital SANE program indicated provider confusion when training to do the SANE exam due to a lack of standardization among how providers completed the exam. Using recommendations provided by the National SANE Protocol, a quality improvement plan was created to evaluate the implementation of an adult/adolescent exam protocol, and a flowchart based on the protocol. Participants completed a pre-and post-survey to determine whether the protocol improved exam standardization, exam clarity, staff awareness of exam policy and procedures, quality of exam, confidence in practice, and clinical support of SANEs. Results: Survey respondents were primarily novice and advanced beginners to the SANE role. Prior to the intervention They had low confidence, low levels of clarity surrounding exam requirements, and a poor sense of clinical support. They report collecting high quality evidence and completing exams in line with policies and procedures. Following the intervention all survey elements increased in level agreement whether there was high agreement pre - intervention. Conclusion: The availability of standardized clinical tools increases confidence, clarity, and support among SANE providers, which we theorize will improve retention of SANEs and evidence quality.