D.9 JDD VAMC 11MH-7 Mental Health Emergency Policy for Community Based Outpatient Clinic.pdf
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JOHN D. DINGELL VA MEDICAL CENTER 11MH-7
DETROIT, MI 48201 September 1, 2016
If policies become expired, this medical center considers policies in effect until rescinded or updated by the policy owner.
Policies and procedures cannot possibly address all situations. Please make sure that you exercise good judgment and common sense. Remember that patient needs always come first.
The hospital prohibits discrimination based on age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation, and gender identity or expression.
MENTAL HEALTH EMERGENCY POLICY FOR THE COMMUNITY BASED
OUTPATIENT CLINC (CBOC)
1. PURPOSE
To define policies, procedures and guidelines governing therapeutic management of patients who manifest suicidal/homicidal behavior, ideation, or present as acutely psychotic.
2. POLICY
It is the policy of the Detroit VA Medical Center and the Community Based Outpatient Clinic (CBOC) that provide care to Veteran to treat the Veteran who expresses intent to harm himself/herself as a suicide risk.
3. DEFINITION
One-to-One precautions: The patient is placed on one-to-one supervision and the patient is on continuous close observation, not left alone at any time. Also the patient is placed in a location away from potentially dangerous objects.
4. RESPONSIBILITY
a. CBOC Providers or DVA mental health providers are responsible for the assessment of suicidal and homicidal risk, or an acutely psychotic condition and the documentation of the assessments in CPRS
b. The Health Tech, Medical Assistant, or designee is responsible for assuring that supervision of the patients on one-to-one precautions occurs according to policy
5. PROCEDURES
a. Patient Identified as high risk for Suicide: Any employee who observes a patient whose behavior suggests a threat to self or others shall take immediate action to protect that patient.
These action may include:
(1) Providing appropriate measures; (one to one observation, talking with patient, remove from potentially dangerous environment)
(2) Reporting patient’s behavior immediately to CBOC provider and or DVA mental health provider.
2.
Medical Center Numbered Memorandum 11MH-7
(3) The provider shall ascertain suicidal/homicidal risk and, if appropriate, order One-to- One precautions. One-to-one precaution supervision will be initiated and maintained until the most appropriate setting (the ED, inpatient admission, or re-addressed as an outpatient) is determined.
(4) If the provider deems the risk to be severe, hospital petition is completed by CBOC staff, 911 will be called to transport the patient to nearby affiliated Emergency Department. For patients emergently transferred to non-VA facilities, please follow the additional steps outlined below.
(5) Complete the CPRS template titled ‘Emergent Interfacility Transfer Form’
(6) Access IMED Consent to complete consent form
(a) If patient is able to sign, please have the patient sign (or verbally consent to the transfer, if verbal please also follow step b.
(b) If the patient is unable to sign, please insure the provider signs the consent. If the patient is considered a suicide risk and refuses to sign , the CBOC staff will start the process for involuntary treatment. This will include completing a petition and a clinical certificate (if physician/psychologist is available).
The steps outlined above should not impede or delay patient care.
b. Management of Patients on One-to-One precautions
(1) Once a patient is placed on One-to-One observation, staff responsible for the patient will remove items which may cause harm e.g., belts, razorblades, lighters, nail files, etc.
(2) A member of the staff is assigned the responsibility to observe the patient.
Documentation by the provider will include an initial assessment, observation, a revised plan of care and summary note by the assigned staff member. Include one-to-one supervision provided by CBOC staff
c. Responding to a Telephone Call from Suicidal Patient Who Threatens Suicide
(1) Telephone calls received from suicidal patients will be managed as follows.
(a) Remain calm letting the caller know that professional help is available and that the Medical Center is interested in helping him/her. Demonstrate a calmness and confidence that you can help. Attempt to get the caller's name, last four numbers of their social security number, phone number, and present location where he/she is calling from and ask if they are alone. If the caller refuses to give this information, do not push the caller for this information. Listen to the caller's statement of the problem in an understanding and empathic manner. If you have a caller ID telephone, please write the number down as soon as you take the call in
3.
the event the caller hangs up on you.
(b) Inform the caller that you may need to put him or her on hold if there is no one around and you do not have anyone available on Lync to assist you. Gather the necessary information, either place the caller on hold, or request another staff member to call 911 to pick up the veteran at the location they provided. Person who calls 911 needs to document the Dispatch or Officer’s Full Name and Badge Number.
(c) STAY ON THE PHONE WITH THE VETERAN UNTIL 911 ARRIVES.
(d) If the Veteran hangs up during the hold or hangs up while you are on the telephone, IMMEDIATELY CALL THE VETERAN BACK. Continue to call back until you successfully reach the veteran in addition to contacting 911 and informing them that the veteran has since hung up on you. Get the dispatch name and badge number and ask them to call you back when information as soon as 911 arrives. If they do not call you back within the hour, you call them back.
(e) If requested by police department, a petition for hospitalization will be completed and faxed.
(f) Some police departments will not take an individual into protective custody and transport without a court order. In these cases, the provider/medical assistant will request a “wellness check.”
6. RESCISSION
Medical Center Numbered Memorandum 11MH-7 Mental Health Emergency Policy for the Community Based Outpatient Clinic (CBOC) dated, October 15, 2012
7. REFERENCES
Medical Center Numbered Memorandum, 11MH-2, Prevention and Management of Suicidal Behavior.
8. FOLLOW-UP RESPONSIBILITY
Primary Care and Mental Health services are responsible for the contents of this Medical Center Numbered Memorandum. Questions can be referred to the Chief of Primary Care or Mental Health
4.
9. EXPIRATION DATE
September 1, 2021 //s// Pamela Reeves, M.D.
Medical Center Director
Distribution: Facility Wide
| MENTAL HEALTH EMERGENCY POLICY FOR THE COMMUNITY BASED OUTPATIENT CLINC (CBOC) |
| 1. PURPOSE |
| 2. POLICY |
| 3. DEFINITION |
| 4. RESPONSIBILITY |
| 5. PROCEDURES |
| 6. RESCISSION |
| 7. REFERENCES |
| 8. FOLLOW-UP RESPONSIBILITY |
| 9. EXPIRATION DATE |
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