Provider expands into electroconvulsive therapy
Provider expands into electroconvulsive therapy
Proposal leads to psychiatric nursing team
One private duty provider's exploratory meeting about a year and a half ago led to development of a unique service and busy specialty nursing team. The neurology, psychiatry, and neurosurgery departments at one of the Henry Ford Health System affiliated hospitals in Detroit wanted a smoother and faster home transition for patients receiving electroconvulsive therapy (ECT) on an outpatient basis.
They contacted Lea Wilson, RN, MBA, director of Henry Ford Extended Care, whose department collaborated with other departments of the hospital to develop protocols and a service agreement for post-ECT home care. Under the arrangement, Henry Ford Extended Care psychiatric-experienced nurses accompany patients home after their ECT, which they receive on an outpatient basis at the Henry Ford-affiliated facility. Most of the patients are chronically depressed and receive ECT monthly to moderate the illness, Wilson reports.
ECT mechanically induces seizures, and patients are monitored in post-seizure status for 45 minutes to an hour in the facility's recovery area. Once patients are stable, the Henry Ford Extended Care nurse accompanies them home, in either the facility's medical van or a private car driven by a family member or friend. The nurse then remains with the patient for at least four hours, monitoring vital signs every 30 minutes and checking reality orientation with, among other things, discussion of current events.
If family members do not accompany the patient home, Henry Ford Extended Care asks them to arrive at least one hour before the nurse's planned departure to assist with the patient's ongoing recovery.
Home recovery proves cost-effective
Henry Ford Extended Care follows four to five ECT patients each month. Although all the patients have some kind of health insurance, under the ECT service arrangement, the facility pays Henry Ford Extended care for each session. Charges vary from $25 to $41 per hour, depending on whether the service is provided by LPNs or RNs and occurs on weekdays or weekends. The hospital determined it was less expensive and more efficacious to have patients continue their recovery at home, according to Wilson.
The ECT program development led to formation of an eight-member psychiatric nursing team whose practice has been interwoven with other Henry Ford Extended Care programs. Wilson says the team is very busy and could do more with more members, but recruitment for the specialized positions is difficult.
The psychiatric team leader, a psychiatric nurse, has a master's degree. The remaining members - one RN and six LPNs - all have psychiatric experience. Because the ECTs are regularly scheduled, the same nurse usually follows the same patient for each treatment.
When not involved in post-ECT monitoring, the psychiatric team stays busy staffing adult day care centers and private psychiatric facilities. And they are now team members on all paraplegic and quadriplegic cases.
For new cases, the psychiatric nurses may help set up the plan of treatment to help address counseling needs and the rage, withdrawal, and psychiatric ideation that often accompanies such catastrophic injuries, Wilson says. "We found we weren't achieving the care plans [of these patients] and believe the psychological and emotional issues were not being addressed as extensively as possible."
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