Patient Monitoring, Communication, and Transport Protocols

Patient Monitoring and Communication

• Vigilant Monitoring:

  • Continuously observe patients for sudden changes in thought or behavior.

• Communication:

  • Engage with the patient and systematically document all interactions throughout care.
  • Advance Notification: Inform the receiving hospital of an incoming patient with a 1013 code or psychiatric emergency to facilitate room and security preparations.

Safety Protocols and Restraint Use

• Documentation:

  • Thoroughly document all actions taken, especially when restraints are utilized.
  • Specify the types and amounts of restraints employed.

• Restraint Procedures:

  • Use a stretcher with appropriate straps in place for patient security.
  • Restrain violent patients only as necessary and maintain constant presence while restrained.

• Case Study:

  • An incident in Florida illustrated the need for secure transport protocols due to a patient escaping during transfer, leading to adjustments favoring SONP transport to mitigate door tampering risks.

Transport Protocols and SOPs

• SONP Transport:

  • Designed for the secure transport of psychiatric patients, ensuring they cannot open doors during transit.

• SOP Challenges:

  • Initial resistance faced from EMS teams due to concerns about manpower, prompting adaptations for various patient demographics (e.g., adults, pediatrics, geriatrics).

• Recording Time:

  • Central systems offer 30 minutes of recording time for patient transports to ensure accountability and monitoring.

Professionalism and Patient Interaction

• Non-Judgmental Approach:

  • Maintain professionalism by avoiding judgmental comments during patient interactions.
  • Personal insights should be addressed only after the patient has been safely dropped off.

• Rehabilitation Focus:

  • Aim for rehabilitating the patient rather than judging their past actions during the transport phase.

Medication and Substance Use Assessment

• Medication Verification:

  • Review the day the medication was filled along with the prescribed amount and remaining quantities.
  • Engage the patient for confirmation regarding their medication intake, ideally doing this regularly.

• Indicator of Misuse:

  • Discrepancies in medication counts may signal misuse or irregular administration patterns.

Understanding Psychosis and Schizophrenia

• Psychosis Definition:

  • A state of disconnect from reality featuring delusions with blurred lines between reality and fantasy.

• Causes of Psychosis:

  • Includes psychiatric conditions, drug abuse, severe stress, and delusional disorders.

• Duration of Symptoms:

  • Symptoms can vary widely from brief episodes to lifelong disorders.

• Presentations of Schizophrenia:

  • Characterized by disorganization, disorientation, and symptoms such as:
  • Talking to oneself
  • Paranoia
  • Auditory and visual hallucinations
  • Erratic speech
  • Lack of interest in pleasurable activities
  • Excessive/reduced motor behavior
  • Insomnia

• Influencing Factors:

  • Biological: Brain damage, genetics, neurobiological influences.
  • Psychological & Social: Various environmental and individual factors impacting mental health.

Assessment Framework: COAST Mnemonic

• C - Consciousness:

  • Monitor for fluctuations in consciousness and differentiate between psychotic episodes and organic brain syndromes.

• O - Orientation:

  • Assess for disturbances in orientation, typically more prevalent in organic disorders.

• A - Activity:

  • Observe for unusual levels of activity (hyperactivity or diminished activity).
  • Note any atypical speech patterns or creation of neologisms.

• S - Thought:

  • Evaluate thought processes for abnormalities, considering indicators like:
  • Flight of ideas
  • Loosening of associations
  • Illusions
  • Thought broadcasting
  • Thought insertion

Key Takeaways

• Safety First:

  • Prioritize safety through consistent monitoring, proper restraint application, and secure transport protocols.

• Effective Communication:

  • Maintain open and clear communication lines with patients and collaborating healthcare facilities.

• Thorough Documentation:

  • Keep comprehensive records of all patient interactions and interventions for legal and medical accountability.

• Professionalism:

  • Approach patient care with a focus on rehabilitation, maintaining a non-judgmental perspective throughout treatment procedures.

• Comprehensive Assessments:

  • Utilize methods like the COAST framework for in-depth patient evaluation, ensuring no aspect of mental status is overlooked.