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AWHONN Conference Case Study

Case Study presentation for 2010 AWHONN conference

Sarah Deardorff Carter

on 4 May 2010

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Transcript of AWHONN Conference Case Study

Case Summary Initial Call - Hospital A 34yo, G3P2, 31wks GA

February 6 - Retrospective Report of positive rapid HIV test

Presented in sickle cell crisis with no prenatal care

Signed consent and referred to PACPI case manager

Left facility and returned later that evening to ER - transported to Hospital B

Left Hospital B AMA on February 9 Second Call - Hospital C February 9
Patient presented in sickle cell crisis to ER

February 11
Patient presented again to ER - transferred to L&D and admitted
Positive rapid HIV test

Left AMA on February 13
Patient determined NOT to have sickle cell - instead is drug seeking Third Call - Hospital D February 13 -Presented to Hospital D

February 16
Positive rapid HIV test reported from L&D
Determined to be same patient as previous two calls
Patient had infected portacath that required removal - refused since she was using it to self-medicate
Conference call arranged with Hotline staff, PACPI case manager, and providers at Hospitals C & D (same Perinatal Network) to determine best course of treatment - decided to start ARV and use incentives from PACPI to convince patient to remain in house.

Patient left AMA February 17
Perinatal Network Administrators in local area notified that patient approximately 33 wks GA complaining of sickle cell crisis might present to one of their institutions and to call the Hotline for assistance. Fourth Call - Hospital E February 18
Positive rapid HIV test report
Patient claims to be from out state and having a sickle cell crisis.

Informed the caller that the Hotline is aware of the patient - patient's medical history includes confirmed HIV+ status and no sickle cell disease.

Perinatal Network Administrator for Hospital E arranged staff conference to determine patient's plan of care and attempt to get infected portacath removed.

Patient left AMA later that evening. Fifth Call - Hospital D February 18
Call from Hospital D reporting that patient returned to their facility shortly after leaving Hospital E.

Patient agreed to stay at hospital, go off IV opiods, start methadone, and take HIV meds.
Patient induced at 35 wks due to MRSA from infected portacath.

Peds ID recommended no NVP due to low viral load and no available resistance information.

DCFS took custody of infant - placed with a relative while patient entered inpatient detox.
Mother completed inpatient drug treatment program with infant; both transferred to recovery home.
Infant confirmed HIV-negative.
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