Intimate Partner Violence Screening Quality Improvement Project Among Pregnant Women at an Urban Obstetrics Clinic

Abstract

Intimate Partner Violence (IPV) is a known risk to pregnant women and their unborn children. Screening for IPV during pregnancy is an important step in identifying abuse and reducing adverse outcomes. The Certified Nurse Midwives (CNMs) serving an urban obstetrics and gynecologic clinic did not have a protocol in place addressing IPV screening among their pregnant population, and did not utilize a screening tool recommended by the United States Preventive Services Task Force (USPSTF). An 11 week quality improvement project was implemented which included a screening protocol, training regarding IPV screening, and use of the Humiliate, Afraid, Rape, Kick (HARK) screening tool. Weekly chart audits of all initial obstetric and postpartum visits were completed. A total of 128 initial obstetric and postpartum visit notes were reviewed. Thirty-seven HARK screens were provided to patients. Of these, 35 were negative, one was positive, and one patient did not complete the screen. Thirty-five screens were not offered to patients due to lack of privacy, patient's primary language was not English, and one patient was treated the prior week for IPV. Fifty-five accounts had no documentation regarding the HARK screen, and one account was not accessed due to an additional privacy feature. This project determined a baseline screening rate for IPV in an urban obstetrics clinic. Further efforts in this clinic should focus on increasing opportunities for privacy between pregnant women and their CNM, incorporating a screening tool into the electronic medical record, and increasing IPV training opportunities for the CNMs.