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Vill REFERRAL FOR ECT A. When the treating psychiatrist determines that a patient is an appropriate candidate for treatment with ECT, he/she will prepare the Clinical Summary for ECT (621 A LIPC) and submit it to the AMD for review. Necessary components of this summary include: 1. Recent laboratory findings: SMA 18, CBC, and B-HCG (if indicated) obtained within the last 30 days. 2. Recent ancillary tests: CXR and EKG, obtained within the last 30 days 3. Medical Review( Previously called medical clearance): this refers to a written consultation with the medical specialist, where any potential medical risk factors are delineated and addressed. 4. Dental assessment 5. Evaluation of Capacity and Capacity statement: The treating psychiatrist shall evaluate whether the patient has the capcity to consent to ECT. This evaluation will be documented in the medical record, and verified by the AMD. a) Patients with capacity will sign the ECT Consent Form(621 B LIPC) b) Patients without capacity must either have a court order or consent of the appropriate surrogate. B. All ongoing psychotropic and medical agents should be reviewed as part of the pre ECT evaluation. When clinically appropriate, agents that increase morbidity or decrease efficacy should be discontinued prior to an acute course of ECT. Such drugs include long acting benzodiazepines, anti-convulsants, lidocaine, reserpine, lithium and theophyllin. 2. During continuation ECT treatment, these drugs may be continued as risk/benefit considerations allow. Drug half-life and withdrawal effects should be considered when discontinuing these agents. Monamine Oxidase Inhibitors should be discontinued prior to ECT. Present evidence suggests that an appreciable drug-free period is not necessary prior to ECT for patients who have been receiving Monoamine Oxidase inhibitors. PILGRIM PSYCHIATRIC CENTER Issue Date: 10/1/97 Revision Date: 2/20/2001 Facility Policy Issuing Office: Clinical Services Reviewed Date:2/20/2001 Page 15 of 58 Subject: ELECTROCONVULSIVE THERAPY (ECT) 4. In general, it is advisable to discontinue psychotropic agents prior to ECT, although this action should not prevent the institution of treatments in a timely manner. The coadministration of antipsychotic medications with ECT, however, is helpful. Attention should be given to specifying which medications are to be administered prior to ECT on the day of each treatment. 6. Seizure patients should continue anticonvulsant treatment. C. In addition, the treating psychiatrist will complete the ECT Target Symptom Sheet (621 D LIPC), to provide a baseline assessment of the severity of the patient's symptoms. This worksheet wil be completed weekly during a course of ECT, and will be integrated into the psychiatrist's overall assessment of the efficacy of the treatment. D. Once the Clinical Summary for ECT is completed, the AMD will review the information and evaluate the patient with regard to capacity and the approriateness of the proposed treatment. If in agreement, then the AMD will sign the summary and forward it to the Director of ECT for further review. E. The Director of ECT will review the summary and discuss the proposed treatment with the treating psychiatrist and/or AMD. On approval from the Director of ECT, the summary will be forwarded to the Clinical Director for final approval. After approval by the Clinical Director, the original packet, including the summary, target worksheet and consent will be placed in the patient's medical record. F. Once the patient has been approved for ECT, the ECT Nurse will coordinate the the date and time of the treatment with the treating psychiatrist and/or AMD. |
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