Deviation in the Standard of Care During Psychiatric Treatment Resulting in Injury

Evaluate breaches in the standard of care by analyzing the answers to the questions herein below to determine whether or not there has been a Deviation in the Standard of Care During Psychiatric Treatment Resulting in Injury

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following symptoms did the patient present? (Choose all that apply)
    Memory deficit
    Disorientation
    Language disturbance
    Behavioral changes
    Delirium
    Altered level of consciousness
    Anxiety
    Emotional withdrawal
    Hallucinations
    Agitation/Hyperactivity
    Suicidal tendency
    None of the above
    Symptoms not elicited/recognized
    Answer unknown
    Why is this important?
    A psychiatric emergency is defined by the American Psychiatric Association as "an acute disturbance in thought, behavior, mood, or social relationship, which requires immediate intervention.
    (2009) 27 EMDCNA 4 669-683

  • Were the patient’s airway, breathing and circulation stabilized? Why is this important?
    Answer this question
    
The Initial evaluation of the patient needs to focus on assessment and stabilization of the vital signs.

    (2009) 27 EMDCNA 4 669-683 



  • Was a medical history obtained? Why is this important?
    Answer this question
    
A detailed medication history is a key component of a thorough psychiatric evaluation, especially in the elderly and those on chronic psychotropic medication.

    (2009) 27 EMDCNA 4 669-683 



  • Was a physical examination performed? Why is this important?
    Answer this question
    
A complete and carefully focused physical examination serves as the core of the diagnostic process.

    Click here for additional information at ClinicalKey.com 



  • Was a mental status examination performed? Why is this important?
    Answer this question
    
The mental status examination is highly informative and necessary to evaluate a patient's mental status. The clinician can apply the Quick Confusion Scale (QCS), which has been validated to assess cognitive function. The QCS is a battery of 6 questions focused on orientation, memory, and concentration. A total score of less than 12 suggests an alteration in cognition.

    (2009) 27 EMDCNA 4 669-683 



  • Was a neurological exam performed? Why is this important?
    Answer this question
    
A thorough neurologic examination needs to include an assessment of orientation, memory, motor strength, sensation, gait, cerebellar functions, reflexes, and a thorough assessment of the cranial nerves.

    (2009) 27 EMDCNA 4 669-683 



  • Which of the following interventions were used to subdue the patient? (Choose all that apply) Why is this important?
    Answer this question
    
The management of the psychiatric patient begins with placing them in a safe setting. If de-escalation techniques fail, the patient may need physical restraint and chemical sedation.

    (2009) 27 EMDCNA 4 669-683 



  • Was a physician's order for the restraints documented in the medical record? Why is this important?
    Answer this question
    
A patient who is at potential risk for suicide or who threatens to leave before an adequate evaluation is completed must be detained. In accordance with the statutes of most states which permit the detention of individuals deemed dangerous to themselves or others, physical restraints must always be preceded by a physician’s order.

    Click here for additional information at ClinicalKey.com 



  • Was the use of restraints documented in the patient’s records? Why is this important?
    Answer this question
    
Documentation needs to include the thought processes behind the decision to restrain, the type of restraints used, and the duration of usage.

    Click here for additional information at ClinicalKey.com 



  • Were the physical restraints assessed for over-tightness after application? Why is this important?
    Answer this question
    
The Assessment Instrument for Mental Health Systems (AIMS) contains recommendations when physical restraints are necessary.

    (2012) 27 EERPSY 2 87-113 



  • How frequently was the patient monitored? Why is this important?
    Answer this question
    
All patient assessments need to be documented in the medical records.

    Click here for additional information at ClinicalKey.com 



  • Was the policy of the healthcare facility followed with regard to frequencey of the patient assessment intervals? Why is this important?
    Answer this question
    
Continuous observation protocols for at-risk patients need to be adhered. The staff of the health care facility must be familiar with and strictly follow the policies and procedures that have been set down.

    (2009) 31 EGHPSY 2 103-109 



  • Were laboratory investigations performed? Why is this important?
    Answer this question
    
Routine laboratory studies can provide important clues to diagnosis.

    Click here for additional information at ClinicalKey.com 



  • Was the patient’s mental condition diagnosed? Why is this important?
    Answer this question
    
Medical conditions can have psychiatric manifestations; therefore it is imperative that the clinician identify any medical illness that may be masquerading as a psychiatric illness.

    (2009) 27 EMDCNA 4 669-683 



  • Was the patient referred to a psychiatrist? Why is this important?
    Answer this question
    
Referral to the appropriate professionals must be made in a timely manner. To deliver care requires a coordinated approach that allows sharing of skills and expertise. The skills of members from all professional disciplines must be utilized.

    Click here for additional information at ClinicalKey.com 



  • Was the patient admitted to a healthcare facility? Why is this important?
    Answer this question
    
If there are any concerns that the individual is a risk to themselves or others, the patient must be admitted to a healthcare facility and placed under observation for a minimum of 72 hours.

    (2012) 30 ENLOGC 1 321-344 



  • Was the patient discharged from the medical facility without treatment for the mental illness? Why is this important?
    Answer this question
    
For the clinician to discharge a psychiatric patient, the following conditions need to be met and must be documented; • the patient is no longer suicidal • the patient is medically stable • the patient will "contract for safety" with the clinician • the patient is clinically sober • the suspicion that the patient has access to firearms is low • the social support, when available, have been contacted • a follow-up is arranged, when possible

    (2009) 27 EMDCNA 4 669-683 



  • Were follow-up evaluations advised? Why is this important?
    Answer this question
    
Regular follow-up physical examinations, laboratory studies and diagnostic imaging evaluations are needed for effective follow-up care.

    (2002) 16 EHOCNA 4 907-926 



  • Was an informed consent obtained? Why is this important?
    Answer this question
    
The laws of most states require that clinicians obtain informed consent before providing treatment.

    (2011) 23 EOMSCA 3 475-484