What actions should be taken if a veteran reports an exposure concern in the (TES) Toxic Exposure Screening but declines follow-up?

Actions for Veterans Declining Follow-up After Toxic Exposure Screening

When a veteran reports an exposure concern in the Toxic Exposure Screening (TES) but declines follow-up, healthcare facilities should document the exposure, provide educational materials, and establish a system to encourage the veteran to return for follow-up testing and evaluation.

Documentation Requirements

• Document the type of exposure reported, including the specific toxic agent(s) if known, and the veteran's decision to decline follow-up 1
• Record the exposure report for completeness and accuracy in the veteran's medical record 1
• Evaluate the risk associated with the reported exposure based on available information 1

Immediate Actions

• Provide written information about the reported exposure and potential health implications to the veteran 1
• Educate the veteran about signs and symptoms that should prompt medical evaluation 1
• Advise the veteran to seek medical evaluation for any acute illness that may occur following the exposure 1

Follow-up Encouragement System

• Develop a system to encourage veterans to return for follow-up testing and evaluation 1
• Consider reaching out to the veteran after the initial screening to reassess their willingness to pursue follow-up care 2
• Monitor completion rates of exposure follow-up to identify systemic issues 1

Special Considerations

• For veterans reporting potential bloodborne pathogen exposures (HBV, HCV, HIV):

  • Provide specific information about recommended baseline and follow-up testing timeframes 1
  • Explain that early identification of infection is possible with appropriate testing 1

• For veterans reporting environmental or combat-related exposures:

  • Document specific exposure details including frequency, duration, proximity, and route 3
  • Provide information about VA resources specific to military environmental exposures 4

Communication Approach

• Use clear, straightforward language when discussing exposure concerns and follow-up options 5
• Acknowledge the veteran's autonomy in healthcare decisions while emphasizing the importance of monitoring 1
• Provide multiple modalities for education about recommended follow-up care 2

Common Pitfalls to Avoid

• Failing to document the veteran's reported exposure concern when they decline follow-up 1
• Not providing written information about the exposure and potential health implications 1
• Waiting too long between exposure identification and outreach, which may reduce follow-up compliance 5
• Not establishing a system to monitor veterans who decline initial follow-up 1

Quality Improvement

• Evaluate the facility's system for monitoring reporting and management of occupational exposures 1
• Review exposure reports to ensure appropriate documentation and follow-up encouragement 1
• Monitor access to care metrics related to exposure follow-up 1
• Assess the effectiveness of educational materials provided to veterans who decline follow-up 2