Growing set of standards for psychiatric care

The Joint Commission has been working closely with several other organizations, including the National Association of Psychiatric Health Systems and the National Association of State Mental Health Program Directors, to collect data and further define the standard of care in psychiatry, notes Alan Lambert, MD, JD, chair of health care practice with the law firm of Butzel Long in New York City. The groups are developing inpatient psychiatric services core measurement sets that will apply to the standard of care. (Editor's note: For more information on those standards, go to http://www.jointcommission.org/PerformanceMeasurement/PerformanceMeasurement/Hospital+Based+Inpatient+Psychiatric+Services.htm.)

For instance, the basic standard for admissions screening specifies that the patient must be assessed for certain criteria, starting with the potential for violence, Lambert explains. The patient also must be assessed for substance abuse, psychologic trauma, and psychiatric strengths that may affect the treatment process.

Other issues addressed in the standards are restraint, seclusion, and patients discharged with multiple antipsychotic medications.

"Another area they're looking at is the post- discharge continuing care plan," he says. "They want to see that there is a plan documented in the medical record. That is important for accreditation, but it also feeds back into the standard of care and liability."

The continuing care plan must be communicated effectively to subsequent health care providers, Lambert says. Failing to do so can increase the risk that the patient will be rehospitalized soon or will harm him- or herself or others.

"Risk managers should be worried about this at a number of levels. First is the accreditation at a state and federal level, because not only do you have the risk of malpractice litigation, but these groups also can come in and levy significant fines and penalties," Lambert says. "Also, once you start putting some of these standards out there, plaintiffs' attorneys start looking at them and trying to feed the standards back into their claims to buttress their allegations of breaches of the standard of care."