Document Type
DNP Project
Publication Date
3-1-2025
Degree Name
Doctor of Nursing Practice
Faculty Advisor
Dr. Kerry Milner DNSc, APRN, FNP-BC, EBP-C
Practice Mentor
Rama B. Rao, MD, FACMT
Abstract
Title: Expediting Toxicological Evidence Collection in Drug-Facilitated Sexual Assault: A Quality Improvement Project
Background/Significance: Drug-facilitated sexual assault (DFSA) involves substance use to incapacitate victims, with rapid drug metabolism necessitating prompt evidence collection. Delays in blood collection reduce toxicology detection rates, compromising legal outcomes. In one New York ED, DFSA kits (Part B) were routinely collected after biological evidence (Part A), creating a critical gap.
Purpose: To improve compliance with evidence-based prioritization of blood collection (Part B before Part A) for DFSA cases through a structured QI initiative.
Methods: The project synthesized evidence from a systematic review of CINAHL, Cochrane, and PubMed databases between 2019-2024, where 5 studies were appraised using Melnyk & Fineout-Overholt’s rapid critical appraisal and synthesis criteria, confirming optimal 12-24h blood collection windows. The project setting was carried out in a busy New York City ED and guided by the IHI Model for Improvement. Interventions included SAFE examiner education, visual workflow cues, and EHR documentation prompts, with compliance tracked via monthly chart reviews (October-December 2024) using PDSA cycles for iterative refinement.
Results: Initial compliance peaked at 100% (3/3 cases) post-implementation but declined to 80% (4/5) in November and 50% (2/4) in December. Barriers included examiner venipuncture discomfort (reliance on ED nurses) and patient consent timing.
Conclusion: While the "blood before bio" protocol is evidence-based, sustained adherence requires workflow integration, examiner skill-building, and patient-centered consent processes. This project demonstrates the feasibility of practice change when guided by synthesized evidence and QI methodology, with implications for forensic nursing standards.
Creative Commons License
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Recommended Citation
Egan, A. (2025). Expediting toxicological evidence collection in patients presenting to the emergency department with report of drug facilitated sexual assault (DFSA): A quality improvement project [Unpublished DNP project]. Sacred Heart University. https://digitalcommons.sacredheart.edu/dnp_projects/90
Comments
A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.