[MCOH-EH] BBPE PEP Declination Form

[Teichman, Ron F]

I would agree. It would be more important to identify why they don't want the PEP. If they can't be convinced the entire conversation should be documented. You may even want to consider having a second provider try to explain and convince the exposed. That will make sure that it isn't a communication or personality issue and also allows there to be a second documenter of the attempts to convince.

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Ron Teichman, M.D., M.P.H., FACOEM, FACP
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From: MCOH-EH <mcoh-eh-bounces at mylist.net> On Behalf Of Leibu, Rachel
Sent: Tuesday, October 24, 2023 2:04 PM
To: MCOH-EH <mcoh-eh at mylist.net>
Subject: [EXTERNAL] Re: [MCOH-EH] BBPE PEP Declination Form

I agree with you, it feels off to me to do so as well for the very reasons you describe. Rachel Leibu, MD, MBA, MS, FACOEM Medical Director Occupational Medicine Services Atlantic Health System Clinical Assistant Professor, Sidney Kimmel Medical

I agree with you, it feels off to me to do so as well for the very reasons you describe.

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

From: MCOH-EH <mcoh-eh-bounces+rachel.leibu=atlantichealth.org at mylist.net<mailto:mcoh-eh-bounces+rachel.leibu=atlantichealth.org at mylist.net>> On Behalf Of Swift, Melanie D., M.D., MPH via MCOH-EH
Sent: Tuesday, October 24, 2023 4:48 PM
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Cc: Swift, Melanie D., M.D., MPH <Swift.Melanie at mayo.edu<mailto:Swift.Melanie at mayo.edu>>
Subject: Re: [MCOH-EH] BBPE PEP Declination Form

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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<mailto:mcoh-eh-bounces at mylist.net>> on behalf of Leibu, Rachel <Rachel.Leibu at atlantichealth.org<mailto:Rachel.Leibu at atlantichealth.org>>
Sent: Tuesday, October 24, 2023 3:48:21 PM
To: MCOH/EH <mcoh-eh at mylist.net<mailto: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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