[MCOH-EH] BBPE PEP Declination Form

[Warner Hudson]

I totally agree with Melanie and have never had people sign a declination in this situation. We handled some 4000  BBP exposures in 8 years at UCLA rarely had resistance to taking the meds for PEP. There was fear for sure but mostly of getting HIV and questions about medication side effects and effectiveness. We never had anyone convert and in the HIV high risk west LA population at the UCLA health system put nearly 25% of those exposures on HIV PEP meds; never had a conversion and managed all the med related side effects without any serious consequences. Make sure your best MD explainer converses with those who have questions or are resistant to the PEP meds. They really do work. Warner 
Sent from my iPhone

> On Oct 24, 2023, at 1:52 PM, Swift, Melanie D., M.D., MPH via MCOH-EH <mcoh-eh at mylist.net> wrote:
> 
> 
> Hi Rachel, if I understand the question, you mean if they've had an exposure for which PEP is strongly recommended (like a deep puncture with a hollow bore device from a known positive HIV source) and the exposed worker declines it - does anyone have them sign a formal declination? 
> 
> Interesting question. I suspect you have a case in mind, yes? I've never asked for a signed PEP declination, but people with those higher risk exposures generally accept PEP anyway. I’d be focused on trying to understand their reasons, so I could help them feel comfortable taking it. 
> I’d certainly do all I could to convince them and then document carefully. 
> 
> I can’t quite put my finger on it, but asking them to sign a declination feels “off” in this situation, almost adversarial somehow. What would be the purpose? Usually a signed declination serves to prove it was strongly recommended (not necessary if you document carefully), to reinforce education (but I’m not letting a high risk exposure go until I am convinced they really understand) and to inform them that they can always get it if they change their mind later (not applicable for HIV or HBV PEP, at least not much later.) 
> 
> Just my two cents. Would be interested if anyone does this and if they’ve found it helpful.
> 
> Melanie
> From: MCOH-EH <mcoh-eh-bounces at mylist.net> on behalf of Leibu, Rachel <Rachel.Leibu at atlantichealth.org>
> Sent: Tuesday, October 24, 2023 3:48:21 PM
> To: MCOH/EH <mcoh-eh at mylist.net>
> Subject: [EXTERNAL] [MCOH-EH] BBPE PEP Declination Form
>  
> Hi,
>  
> Does anyone ask an employee who has had a bloodborne pathogen to decline HIV PEP if offered and they do not want to take it?
>  
> Rachel Leibu, MD, MBA, MS, FACOEM
> Medical Director Occupational Medicine Services
> Atlantic Health System
> Clinical Assistant Professor, Sidney Kimmel Medical College
> at Thomas Jefferson University
>  
> Office 973-829-4277
> Cell 973-886-6708
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