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.