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@gmail.com C: 502-510-7221


On Tue, Dec 10, 2024 at 8:00 PM Hayden, Jamie R <JHayden@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

 

Jamie Hayden RN, BSN
she/her/hers – What are personal pronouns?
Lead RN
Employee Health Services
700 University Bay Drive Suite 101

Madison, WI 53705
Office: (608) 263-7535
jhayden@uwhealth.org

 

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