[MCOH-EH] Delayed Source Patient HIV Results

[Jolene Mitchell]

This is not a clean answer. If your lab operates and reports out after
business hours then you may get the results but very few pharmacies carry
PEP due to cost especially  24 hour pharmacies. Many box store pharmacies
rotate which pharmacy is 24 hours so you have to keep up to date. Do you
have an after hours system to secure the PEP?

First asses the clinical risk of HIV and Hep C.
Discuss the risk and communicate with the exposed so they understand the
risk of not knowing source labs and med risk in consideration of the other
comorbidities I.e. pregnancy.
The physician contract must cover the cost of after hours call if you are
going to request they work more hours.
You must have access to after hours labs.
Must have access to PEP 24 hours.
Some ERs carry PEP but only for their hospital employees, is this an option
for your organization.
My least favorite is to send them to ED but it is high risk, a 10 hour ED
wait postpones PEP and not all hospital pharmacies are open to the public
24/7. Plus source testing must get to ED.

PEP is most effective in the first few hours but can still be effective in
24-36 hours.

Please use the 24/7 PEP hotline.

This is never easy and always unnerving but having a solid system in place
can help. Even the most perfect system will have cases when PEP cannot be
started timely or labs are not timely. In some clinics this is the norm
because the labs are sent out and there is no real STAT option


Hope this helps,


Jolene Mitchell, DO Mitchell.jolene7020 at gmail.com C: 502-510-7221


On Tue, Dec 10, 2024 at 8:00 PM Hayden, Jamie R <JHayden at uwhealth.org>
wrote:

> Hello,
>
>
>
> I am interested in understanding what other organizations do for blood and
> body fluid exposures for if/when a source patient’s HIV test results are
> not back before the Employee Health Clinic closes. Does a clinician follow
> up the next business day since HIV PEP can be initiated within 72 hours of
> exposure? Do you start the employee on HIV PEP until the results are
> received?
>
>
>
> Or does a clinician stay on-call to receive those results later in the
> evening and follows up with the employee once the results are received? If
> this is the case and the employee requires HIV PEP due to a positive HIV
> test result, where does the individual present to obtain the medications?
>
>
>
> Any information would be much appreciated!
>
>
>
> Thank you,
>
> Jamie
>
> <https://www.google.com/maps/search/700+University+Bay+Drive+Suite+101+%0D%0A+Madison,+WI+53705+%0D%0AOffice:+(608?entry=gmail&source=g>
>
>
>
> *Jamie Hayden RN, BSN*
> she/her/hers – What are personal pronouns? <https://www.mypronouns.org/>
> Lead RN
> Employee Health Services
> 700 University Bay Drive Suite 101
> <https://www.google.com/maps/search/700+University+Bay+Drive+Suite+101+%0D%0A+Madison,+WI+53705+%0D%0AOffice:+(608?entry=gmail&source=g>
>
> Madison, WI 53705
> <https://www.google.com/maps/search/700+University+Bay+Drive+Suite+101+%0D%0A+Madison,+WI+53705+%0D%0AOffice:+(608?entry=gmail&source=g>
> Office: (608
> <https://www.google.com/maps/search/700+University+Bay+Drive+Suite+101+%0D%0A+Madison,+WI+53705+%0D%0AOffice:+(608?entry=gmail&source=g>)
> 263-7535
> jhayden at uwhealth.org
> <xxxx at uwhealth.org>
>
>
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