PILGRIM PSYCHIATRIC CENTER

CLINICAL POLICY

ELECTROCONVULSIVE THERAPY

Issued: November 1997

Revised: February 2000

Revised: February 2001

PILGRIM PSYCHIATRIC CENTER

Issue Date: 10/1/97 Revision Date: 2/20/2001

Reviewed Date:2/20/2001 Page 2 of 58

Subject: ELECTROCONVULSIVE THERAPY

Facility Policy

TABLE OF CONTENTS

POLICY ....

DEFINITIONS .....

INDICATIONS FOR USE

General Statement
Primary Use of ECT
Secondary Use of ECT
Major Diagnostic Indications or
Mood Disorders ......
Schizophrenia and Other Functional Psychoses
Other Diagnostic Indications ....................

CONTRAINDICATIONS AND SITUATIONS OF HIGH RISK

ADVERSE EFFECTS ...........

Cognitive Dysfunction ......
Cardiovascular Dysfunction 9 .........
Treatment Emergent Mania ...
Adverse Subjective Reactions .
Other Adverse Effects ........
Prolonged Apnea . .
Prolonged Seizures

CONSENT FOR ECT ......................

General Principles ........
Characteristics of Informed Consent .....
Frequency of Obtaining Consent ........
Capacity for Consent .................
Patients Having Capacity to Provide Consent ......
Patients Lacking the Capacity to Provide Consent . .

USE OF ECT IN SPECIAL POPULATIONS

The Elderly ....................
Pregnancy ......................
Concurrent Medical Illness ........

..10 ..10

..12 ..12 ..13

PILGRIM PSYCHIATRIC CENTER Facility Policy Issuing Office: Clinical Services

Issue Date: 10/1/97 Revision Date: 2/20/2001 Reviewed Date:2/20/2001 Page 3 of 58 PY

Subject: ELECTROCONVULSIVE THERAPY

REFERRAL FOR ECT

FREQUENCY AND NUMBER OF TREATMENTS DURING AN ACUTE COURSE OF ECT ..........................................................

PREPARATION FOR TREATMENT ........................

TREATMENT PROCEDURES ....

Patient Preparation ..........
Monitoring ...........................
Airway and Anesthetic Management .......
ECT Seizure Induction ...........................................
Transfer of Patients from the Treatment Area to the Recovery Area .......
Management of the Patient in the Recovery Area ......................

17 .17 .18 .19 .21 .23 23

POST TREATMENT ..........

Return to the Ward ......
Evaluation of Outcome . .

MANAGEMENT OF THE PATIENT'S POST ECT COURSE:
CONTINUATION/ MAINTENANCE ECT ............................................

General Considerations ...............................................
Assessments and Documentation ......................................

BRIEF INPATIENT ADMISSION FOR ECT

General Considerations ...........
Referral Process .....................................
Admission Process ........................................
ECT Procedure .......................
Discharge ..................................
Interim Monitoring ..........................

24 25 25

..26 ...26 27

... 28 ... 28 28

... 29

... 30 ..31 ..31

CLINICAL MANAGEMENT OF POTENTIAL ADVERSE EVENTS 32

Management of Post Ictal Agitation 32
Missed, Abortive, Inadequate, or Prolonged Seizures 33
Situations Where Increases in Stimulus Dosage Are Insufficient to Elicit an Adequate Seizure Prolonged Seizures

APPENDIX I: DETERMINATION OF ECT ELECTRODE PLACEMENT AND STIMULUS DOSING 35

PILGRIM PSYCHIATRIC CENTER Issue Date: 10/1/97 Revision Date: 2/20/2001 Facility Policy Reviewed Date:2/20/2001 Page 4 of 58

Issuing Office: Clinical Services Subject: ELECTROCONVULSIVE THERAPY (ECT)

Stimulus Dosing ......

APPENDIX II: STAFFING Responsibilities

APPENDIX III LOCATION, EQUIPMENT, AND SUPPLIES

The Treatment Suite .................................
Equipment ........................................
Treatment Area
Recovery Area
Primary Medications ...
Additional Medications .
Other Necessary Supplies
Machine Safety .......

... 37

..38

.................. 38

..38 ..39 .39 40 40 40 .41

APPENDIX IV GENERAL GUIDELINES ON PATIENT ELIGIBILITY FOR AMBULATORY SURGERY BASED ON MEDICAL CONDITION..41

APPENDIX V FORMS

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