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XIV. BRIEF INPATIENT ADMISSION FOR ECT A. General Considerations: In order to facilitate the treatment of patients in a community setting, Pilgrim Psychiatric Center will provide ongoing continuation/maintenance ECT to discharged patients who have received and responded to ECT while hospitalized at PPC, and are unable to secure ECT in the private sector. Except where noted below, the policies and procedures governing the use of ECT in discharged patients are identical to those for patients currently hospitalized at PPC. B. Referral Process The inpatient Treating Psychiatrist, in consultation with the AMD and Director of ECT will identify appropriate candidates prior to their discharge from PPC. The original Clinical Summary for ECT (621 A LIPC) with an addendum commenting on the response to ECT, the rationale for recommending outpatient maintenance treatment, and a signed consent for this outpatient maintenance treatment will be submitted to the Clinical Director for approval. If approved, the Director of ECT will inform the treatment team. 2. When the discharged patient requires a brief inpatient admission for ECT, the Director of ECT will be responsible for coordinating this admission with the PILGRIM PSYCHIATRIC CENTER issue Date: 10/1/97 Revision Date: 2/20/2001 Facility Policy Reviewed Date:2/20/2001 Page 28 of 58 Issuing Office: Clinical Services es I Subject: ELECTROCONVULSIVE THERAPY (ECT) Chief of Service, (who will insure that a bed is available), the clinic/ECT staff, and the anesthetist. 3. The inpatient Social Worker will be responsible for collecting the pertinent clinical information from the medical record, and providing copies to the Director of ECT. This information will be included in the binder prepared for the Brief Inpatient Admission for ECT and includes the following: a. Patient Photograph and alert sheet b. Admission Screening Form Demographic Information (ADM 725) c. Core History Data Sheet (410A Med LIPC) includes current contact sheet d. Acknowledgment Form for Advanced Directives (Health Care Proxy If applicable) e. Education Assessment f. Trauma Screen/Assessment g. Nutritional evaluation h. Clinical Summary for ECT with addendum requesting outpatient maintenance i. Consent for Outpatient maintenance ECT j. Discharge Summary and Service Plan k. Pertinent laboratory tests, including EKG and CXR reports. C. Admission Process 1. The patient wil be admitted directly to ward 102 by 2 pm on the day prior to the scheduled ECT. 2. The preparation of the medical record binder will be completed by the ward staff of 102, and will include the documents listed under Section XIV B3 of this policy. (The Director of ECT will insure that the ward staff of 102 has the pertinent documents.) 3. The designated Psychiatrist on ward 102 will admit the patient to PPC and complete the following: a. Screening Admission Note: This should incorporate the interim clinical Information provided by the outpatient psychiatrist, (see lnterim Monitoring Section), and include a mental status and mini- mental status examination. PILGRIM PSYCHIATRIC CENTER Issue Date: 10/1/97 Revision Date: 2/20/2001 Facility Policy Reviewed Date:2/20/2001 Page 29 of 58 Issuing Office: Clinical Services Subject: ELECTROCONVULSIVE THERAPY (ECT) b. Admission orders and orders for ECT, including orders for standing medication and pertinent lab tests. c. Legal Papers: Patient must be admitted on a voluntary status. d. Review and update any pertinent information on the following: i. 725 ADM- sign and date the updated form and fax a copy to medical records. ii. Acknowledgement form for Advanced Directives iii. ECT consent- Informed consent must be obtained every 6 months. e. The Clinical Summary for ECT and the consent for the treatments must be completed every 6 months by the Outpatient Psychiatrist, (who will be responsible for sending this information to the Director of ECT. 4. The medical specialist assigned to ward 102 (or designee) will complete the Physical Examination and Assessment (34 Med). a. Any pertinent physical findings or interim medical history that would interfere with ECT should be immediately reported to the Director of ECT. b. If the patient is being readmitted for a brief ECT admission within 30 days of the last complete physical examination, then the medical specialist may update the physical examination, as indicated, on a continuation sheet. The pain management screen and assessment will be completed each time the physical examination is performed. 5. The Anesthetist will evaluate the patient prior to ECT and complete the Pre Anesthesia Evaluation Form. 6. The Social Worker will review the Core History and update as indicated including the contact sheet. 7. The Ward Nurse 102 will complete the Nursing Core Assessment, including the body chart and Nursing Assessment Part 1. D. ECT Procedure 1. Once admitted, all policies and procedures pertaining to the use of ECT for PILGRIM PSYCHIATRIC CENTER Issue Date: 10/1/97 Revision Date: 2/20/2001 Facility Policy Reviewed Date:2/20/2001 Page 30 of 58 Issuing Office: Clinical Services Subject: ELECTROCONVULSIVE THERAPY (ECT) inpatients will be followed. 2. The ECT Psychiatrist will complete the ECT Procedure Note and the relevant section of the Pre/Post ECT Progress Note. Any special instructions for patient monitoring will be documented on a separate progress note which will be placed in the medical record. A copy of this note will be included in the discharge packet that will be forwarded to the outpatient psychiatrist. The ECT Nurse will give the ECT Discharge instruction sheet to the patient and review the information with them before discharge for the recovery area. E. Discharge 1 Patients will not be discharged from PPC following ECT unless the following criteria are met: a. The patient must be alert and oriented ( to the extent of the baseline mental status) b. Vital signs are stable (within 20% of baseline) c. The patient is ambulatory ( within baseline parameters) d. The patient's gag reflex and coughing and swallowing ability are intact. 2. The designated Psychiatrist on ward 102 will complete the discharge summary Service Plan Part I and the 116 ADM(to be faxed to medical records) as per facility requirements. The summary should include the date of the next scheduled treatment. A copy of the discharge summary should be forwarded to the outpatient clinic. 3. The Social Worker will update the the Discharge Summary/Service Plan (440 A Med LIPC), including the plan for outpatient treatment. The patient will be given a copy of this at discharge, including a phone number of a contact staff person for any problems. 4. The ward Nurse will complete the Nursing Service Discharge Note Instructions to Patient (105R LIPC). A copy of this will be forwarded to the outpatient clinic. F. Interim Monitoring PILGRIM PSYCHIATRIC CENTER issue Date: 10/1/97 Revision Date: 2/20/2001 Facility Policy Reviewed Date:2/20/2001 Page 31 of 58 Issuing Office: Clinical Services Subject: ELECTROCONVULSIVE THERAPY (ECT) 1. Each patient receiving this treatment modality will be seen by the outpatient psychiatrist at least monthly. The outpatient psychiatrist must document th patients' functioning including their current mental status and response to treatment on a progress note and forward a copy to the Director of ECT at fax # 761-3559, prior to the next scheduled treatment. The information on this note should be incorporated in the screening admission note completed by the admitting ECT Psychiatrist, and the note itself should be included in the medical record. Any significant changes in the patient's medical or mental condition that would impact on ECT treatments will be immediately reported to the Director of ECT by phone(x 2138). 3. The outpatient Psychiatrist will work in coordination with the ECT team to obtain any necessary lab work. At a minimum, or more frequently, if clinically indicated, the following lab tests are required: a. CBC, SMA 20, UA: every 30 days b. EKG: annually unless the patient is over 40 years old, the q 6 months C. CXR: annually d. TFT's: annually e. Stool for occult blood: annually only if the patient is more than 40 yrs. old. f. PPD: annually g. Blood levels: as clinically indicated. h. B-HCG when clinically indicated. The Outpatient Psychiatrist is responsible for updating the Clinical Summary for ECT, and obtaining informed consent for this treatment every 6 months. |
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