Use these tips if you suspect rabies

Whether to treat is a 'complicated decision'

The type of rabies previously found in dogs in the United States has been eliminated, according to the Centers for Disease Control and Prevention (CDC). However, the disease remains a human threat, particularly in bats, and rabies can be transmitted to dogs or other pets by other wildlife, says the CDC.

Determining which patients require rabies post-exposure prophylaxis (PEP) is "a complicated decision," says Karen Hust, RN-CEN, MSN, BSN, ADN, advanced clinical educator at the ED at St. Joseph's/Candler Hospital in Savannah, GA.

"It varies based on several factors," says Hust. You must consider the severity and type of animal exposure such as bite or scratch, the condition of the animal, whether the animal can be identified and caught, and the location of the exposure on the patient, says Hust.

Pre-printed order form helps

At St. Josephs/Candler, a computerized tool was created to make this decision easier, says Hust. "Ordering and administration of the rabies PEP has been made less complicated and safer for our patients by utilizing a pre-printed order form."

First, the physician indicates if the patient has ever been previously vaccinated and whether the patient is there for initial exposure or follow-up. The form then delineates the correct dosage and administration information based on the physician's selection. Requiring use of the pre-printed orders helps prevent medication errors.

Next, ED nurses document their assessment information electronically. "If they indicate this is the patient's first ED visit for a potential rabies exposure, the computer automatically generates a report that is populated with the patient demographic and pertinent exposure information," says Hust. "This is faxed to the appropriate government agency as required by our laws for potential rabies exposure reporting."