Download CC.000 Plan for the Provision of Care (PDF: 242KB/38 pages)

POLICY/PROCEDURE
Title:
Issued By: Clinical Services
Plan for the
Provision of Care
Policy No.: CC .000
Date Issued: 10/98
Date Reviewed/Revised: 5/99, 10/00, 4/01, 3/02, 3/03
Approved:
Leadership - 5/18/99, 4/9/01
Clinical Services Function – 8/05/02, 5/15/03
Medical Executive Committee – 10/98, 2/99,
6/17/99, 7/15/99, 5/17/01, 8/23/02, 5/15/03
Board of Trustees– 10/98, 2/99, 6/24/99, 8/23/99,
5/24/01, 8/23/02, 5/15/03
I.0
INTRODUCTION
Prairie St. John’s is a private, freestanding health care facility that specializes in
psychiatric and chemical dependency treatment. Inpatient care is provided on a
24-hour basis, seven days a week, in a 53 bed acute care psychiatric setting.
Outpatient and partial hospitalization services are provided on a 5-day per week
basis, days and evenings.
2.0
PHILOSOPHY AND PURPOSE
We believe that mind, body and spirit exist as an inseparable unit and that our
responsibility is to treat the total person in the knowledge that pathology in one
affects the level of functioning in the other. We believe that the human being is a
delicate balance of emotional, intellectual, physical, and spiritual dimensions.
Psychiatric disorders result in disturbances in thought, behavior and affective
processes. These disturbances impair the patient's ability to perform basic life roles
and severely disrupt family, social, and educational relationships, which can be
ameliorated by prompt psychiatric care.
Page 1 of 37
Prairie St. John’s is committed to the provision of quality behavioral health services
to our community. This commitment is demonstrated through the facility's mission
and supported through effective strategic and budget planning efforts. Resources
are utilized to meet individual patient, family and staff goals in the most effective
and efficient manner possible. The best principles and most current information
available about human behavior are incorporated into the plan of care for each
program.
Prairie St. John’s provides a comprehensive therapeutic environment through an
individualized treatment program for each patient. This is achieved through group,
family, marital, educational, and activity therapies, and the focus is on the patient
as a unique individual. Care is provided according to an established code of
ethical conduct and strict adherence to patient rights. Involvement of the family,
whenever possible, is encouraged to promote support for the patient's recovery.
We offer patient centered care, and support our holistic philosophy with a full
continuum of care. Resources are organized around each patient through the
development of an individualized, comprehensive treatment plan. The patient's
strengths provide the cornerstone of the treatment plan and are mobilized from
admission, throughout hospitalization and into discharge. Responsibility for the well
being of the patient is recognized as being in the patient's hands as soon as
possible.
3.0
ORGANIZATION
Prairie St. John’s is a freestanding psychiatric facility with its own Board of Trustees,
CEO, Clinical/Nursing Services Director, and Clinical and Business Services
Functions. The Board of Trustees, as the governing body of Prairie, has ultimate
responsibility and authority for all patient care services provided as described fully
in its Bylaws. The Board strives to assure that a comparable level of care is provided
to patients in all units, areas or departments throughout the facility. The Medical
Executive Committee, as the executive body of the medical staff, is accountable
to the Governing Body for clinical and administrative aspects of patient care, as
well as performance improvement activities. The committee is chaired by the
Chief the Medical Staff and provides a forum for discussion and review of clinical
activities. Medical staff accountability to the Medical Executive Committee is
defined fully in the Medical Staff Bylaws.
The Clinical Services Function consists of the CEO, Clinical/Nursing Services Director,
Medical Director/Physician Executive, Chief of Staff/Physician Executive, and
Quality Management Director. The Business Services Function consists of the CEO,
Chief Financial Officer, Human Resources and Quality Management Directors. The
functions work with the Executive Committee of the Board of Trustees and the
Page 2 of 37
Medical Executive Committee as the organizational planning bodies for budget,
staffing and programmatic direction and patient care. . For a summary of various
forms of interdisciplinary deliberation or review, see the Master Meeting Schedule
(attached).
Prairie utilizes the "medical model" for patient treatment with a strong emphasis on
interdisciplinary input in terms of screening, evaluation, diagnosis and treatment of
patients. Staff providing treatment as part of the interdisciplinary team include the
psychiatrist, nurse(s), social worker, activities therapist, group therapist(s) and
individual and/or family therapist. Substance abuse counselors, chaplains and
teachers participate as members of the treatment team as appropriate. All
disciplines complete assessments within the first 72 hours, summarize, present their
findings and develop a comprehensive treatment plan. The plan contains the
following:
♦ Specific interventions that relate to goals, written in behavioral and
measurable terms and include expected achievement dates as well as
the person responsible for implementation.
♦ Specific discharge criteria necessary for the individual patient to achieve
and maintain, emotional, physical, social and vocational/recreational
stability as deemed appropriate for the patient’s capabilities.
♦ Referral for needed services for the individual patient not provided
directly by the hospital and
♦ A plan for involving family and/or significant others when appropriate.
All team members are responsible to the team leader, who is the attending
physician. General functions of team members are described for employees by
their respective job descriptions. Physicians and therapists who are independent
practitioners provide treatment consistent with clinical privileges defined through
the medical staff credentialing process.
Treatment teams are organized in accordance with the services provided. All
treatment modalities are designed according to the type and level of care. The
attending psychiatrist supervises the clinical work of his or her team members. The
Clinical/Nursing Services Director supervises the clinical group functions and clinical
staff of nursing, chemical dependency, occupational therapy/activity therapy
services, and social services.
Service and Clinical Department Supervisors meet on twice monthly as a team with
the Nursing/Clinical Services Director. The focus on these meetings includes
treatment issues, overall programming, and quality management activities.
Each department has a director or supervisor who is responsible to the CEO and
Physician Executives. Department directors and Supervisors are accountable for
Page 3 of 37
the overall functioning of their departments, especially in the areas of
competency, maintaining high standards of ethics, timely performance evaluation,
providing appropriate inservice education, and performance improvement
activities. (Reference Leadership Plan LD.002)
The organizational relationship of the programs, channels of staff communication,
responsibility, authority and supervisory relationships are depicted in the
organizational chart attached and made a part hereof. Each department has a
description of its organizational structure, channels of communication and
interdisciplinary collaboration relative to the overall philosophy and goals of Prairie.
Patient support is provided by a variety of individual departments, which may not
have direct contact with the patients, but who support the care provided by the
hands-on care providers. All services, whether patient care or patient support
services are available to ensure care and services are maintained in an
uninterrupted and continuous manner.
4.0
PROGRAMS
The staff of Prairie believes in and strives to maintain a total therapeutic
environment through an individualized treatment approach for each patient and
family. Each program is designed to provide services appropriate to the scope
and level of care required by the patient population served.
A multi-disciplinary staff provides comprehensive treatment-oriented activities.
Clinical staff provide individual therapy, group therapy, family therapy,
occupational therapy, activity therapy, and educational services. All clinical
services are delivered by qualified professional staff including, but not limited to,
psychiatrists, registered nurses, licensed practical nurses, behavioral health
technicians, clinical social workers, psychologists, chaplains, teachers, a dietician,
pharmacist, licensed addiction counselors and activity or occupational therapists.
Clinical services that are not available within the facility may be provided through
referral, consultation or contractual agreements with area professionals and other
health care facilities. (e.g. Education staff, physical therapy,, dietician, laboratory,
pharmacy)
The goal of treatment is to promote the highest level of functioning for each
patient with emphasis on individual, group and family therapy provided at the least
restrictive level of care. The patient's symptoms, strengths, family support and
discharge needs provide the basis for care from admission to discharge. The
programs provide for a continuum of care from more intensive to less intensive
treatment options.
Page 4 of 37
4.1
Adult Programs
4.1.1 Adult Inpatient Mental Illness Program
The adult inpatient mental illness program is designed for the
treatment of adult patients, ages 18 and over, with primary psychiatric
diagnoses. Some patients may have a secondary substance abuse
diagnosis who meet the criteria for medically supervised in-patient
treatment. The following patients are excluded:
4.1.1 Disorders caused by chronic organic brain dysfunction without
treatable psychiatric symptoms.
4.1.2 Behavioral, cognitive and/or physical impairment which would
render the patient unable to function at a minimally
acceptable level within the treatment program, such as a
medically unstable patient whose safety requires treatment in a
medical-surgical hospital.
4.1.3 Those who meet criteria for less restrictive treatment.
The programs are based in an acute-care setting, in a 24 (twenty-four)
bed unit, and is in operation 24 hours per day, seven days per week
and include.
AREAS OF CARE
SERVICE PROVIDERS
Psychiatric Evaluation Psychiatrists
Psychosocial AssessmentSocial Services Staff
Nursing Assessment
Registered Nurses
History and Physical Exam
PA or Physician
Medical/Surgical Consults
Physicians
Dietary Consults
Registered Dietitian
Psychological Screening
Psychologists
and/or Testing
Neuropsychological
Psychologists
Evaluation
Diagnostic Testing:
Lab, EKG
Physicians
Activity Therapy
Therapeutic Recreation Specialist
Occupational Therapist
Page 5 of 37
Individual/Family/Group
Therapy
Continuing Care Planning
Spiritual Assessments and
Pastoral Counseling
Counselors and
Social Services Staff
Social Services Staff
and Treatment Team
Chaplain
4.1.2 Adult Inpatient Chemical Dependency (CD) Program
The Adult Inpatient Chemical Dependency Program is designed for
the treatment of patients, ages 18 or over with a primary diagnosis of
chemical dependency who meet the criteria for medically supervised
inpatient treatment. Patients who are so medically fragile that their
safety demands treatment in a medical/surgical setting, or who are so
mentally impaired that they cannot reasonably benefit from less
restrictive treatment. The program operates 24 hours per day, seven
days per week in an acute care setting, and operates on the Adult
Unit. Areas of care provided by identified service providers are the
same as for the Adult Mental Illness Program with the following
additions:
AREAS OF CARE
SERVICE PROVIDERS
Chemical Dependency Licensed Addiction Counselors
Assessment
4.1.3 Adult Inpatient Dual Diagnosis Program
The Adult Inpatient Dual Diagnosis Program is designed for the
treatment of patients, ages 18 and over who meet criteria for inpatient
psychiatric treatment and for chemical dependency treatment.
Areas of care provided by identified service providers are the same
as for the Adult Mental Illness Program with the following additions:
AREAS OF CARE
SERVICE PROVIDERS
Chemical Dependency Licensed Addiction Counselors
Assessment
4.1.4
Adult Partial Hospitalization Program
This program is designed to meet the increasing need for variations in
psychiatric care. The program provides care for patients 18 years of
Page 6 of 37
age or older if developmentally appropriate. Individuals with less
intensive treatment needs than those addressed through the
in-patient setting benefit from this program.
Patients participate in either the:
a.
b.
c.
Mental Health Track
Dual Diagnosis Track
Chemical Dependency Track
The program is in operation 5 days per week, 6 hours per day. Areas of
care by identified service providers are the same as those provided
through the Adult Mental Illness Program. Level of care will be
determined by the admitting/attending psychiatrist.
For those patients who meet the criteria for the Adult Partial Program
and do not have a stable home where they would be geographically
too far to commute for treatment, transitional housing (see policy
TX.001.4) is available.
4.1.5 Adult Mental Illness Day Treatment
This program is designed for the treatment of patients ages 18 and
over, with a primary psychiatric diagnosis.
The program is in operation 3 days per week, 4 hours per day. Areas of
care are provided by the following service providers.
SERVICE PROVIDERS
AREAS OF CARE
Case Management
Social Work
Psychiatry Supervision
MD – Psychiatry
Symptom Management/Medication Ed.
RN
OT Coping Skills
OTR/L
OT Healthy Life Skills
OTR/L
Cognitive Behavioral Skills
Psychology
Health Care Screening
RN
Other services as provided by the Adult Mental Illness and/or
Addicitve Disease Programs are available and will be utilized based
upon individual need.
Page 7 of 37
4.1.6 Adult Chemical Dependency Day Treatment Outpatient Program
This program is designed for the treatment of patients, ages 18 or over,
with a primary diagnosis of alcohol and/or drug dependency who
meet the criteria for medically supervised day treatment outpatient
services. Those patients who are individually unstable or who are so
impaired that they cannot benefit form outpatient treatment may be
excluded.
The program is in operation varying between 4.5 hours and 8.5 hours
per day for a total of 21 hours per week.
AREAS OF CARE
SERVICE PROVIDERS
Psychosocial Data base
Social Services Staff / Needs
Assessment Staff
Physicians, RN, Qualified Medical Staff
Licensed Counselors, LAC. and other
staff as needed
Psychiatrist, Social Service and Nursing
Staff, LAC
Treatment Team and other staff as
needed
LAC, and other Qualified Staff
Health Care Screening
Individual/Group Therapy
Continuing Care Planning
Lectures
4.1.7 Adult Chemical Dependency Intensive Outpatient Program
This program is designed for the treatment of patients, ages 18 or over,
with a primary diagnosis of alcohol and/or drug dependency who
meet the criteria for medically-supervised, intensive outpatient
treatment. Those patients who are medically unstable or who are so
impaired that they cannot benefit from outpatient treatment may be
excluded.
The Intensive Outpatient Program is in operation for three (3)hours per
day, Monday, through Friday of each week.
The Areas of Care and Service Providers match that of the Adult Day
Page 8 of 37
Treatment Program listed above.
Other services as provided for the Adult Psychiatric and/or Adult
Addictive Disease Programs are available and will be utilized based
upon individual need.
Page 9 of 37
4.1.8 Adult Chemical Dependency Low Intensive Outpatient Program
This program is designed for the treatment of patients 18 years of age
and older with a primary diagnosis of alcohol and/or drug
dependency who have successfully benefited from Intensive
Outpatient Services. Patients receive three (3) hours of programming
per day for 1-3 times per week.
AREAS OF CARE
lecture
group therapy
psychoeducation
4.2
SERVICE PROVIDERS
LAC
LAC
LSW
Pediatric Programs
4.2.1 Adolescent Inpatient Treatment Program
The Adolescent Inpatient Treatment Program is designed for the
treatment of adolescents, ages 12 through 18 or older is
developmentally appropriate, with primary psychiatric diagnoses who
meet the criteria for medically-supervised, inpatient acute treatment.
Patients participate in either the:
a.
b.
c.
Mental Health Track
Dual Diagnosis Track
Chemical Dependency Track
The program operates 24 hours per day, seven days per week, on a
twenty-nine (29) bed unit, in an acute care setting. Sharing resources
with the children’s inpatient treatment program. Areas of care
provided by identified service providers are the same as for Adult
Inpatient Psychiatric Treatment with the following additions:
AREAS OF CARE
SERVICE PROVIDERS
Education Assessment
Speech, Language and
Hearing Testing
Developmental History
Certified Teachers
Speech Language Therapist
Social Services and Nursing Staff
Page 10 of 37
4.2.2 Children's Treatment Program
The Children's Inpatient Program shares space with the Adolescent
Inpatient Treatment program on a twenty-nine (29) bed unit in an
acute care setting. The program is generally designed for the
treatment of children less than 12, with primary psychiatric diagnoses
who meet the criteria for medically supervised, in-patient treatment.
Excluded are those patients who are so medically unstable that their
safety requires treatment in a medical-surgical hospital; those who are
so behaviorally or cognitively impaired that they cannot benefit from
treatment in a less restrictive setting; those who meet criteria for less
restrictive treatment; or those with chronic organic brain dysfunction
without treatable psychiatric symptoms.
Patients participate in either the:
a.
b.
c.
Mental Health Track
Dual Diagnosis Track
Chemical Dependency Track
The program is in operation 24 hours per day, seven days per week.
Areas of care provided by identified service providers are the same as
for the Adolescent Psychiatric Program.
4.2.3 Pediatric Partial Hospitalization Program
This program is designed to meet the increasing need for variations in
psychiatric care. The program provides care for patients up to 18 years
of age, or older if developmentally appropriate. Individuals with less
intensive treatment needs than those addressed through the in-patient
setting benefit from this program.
Patients participate in either the:
a.
b.
c.
Mental Health Track
Dual Diagnosis Track
Chemical Dependency Track
The program is in operation 5 days per week, 6 hours per day. Areas of
care by identified service providers are the same as those provided
through the Pediatric Psychiatric Program. Level of Care will be
determined by the admitting/attending psychiatrist.
Page 11 of 37
4.2.4 Adolescent Chemical Dependency Day Treatment Program
This program is designed for the treatment of patients up to 18 years of
age with A primary diagnosis of alcohol and/or drug dependency
who meet the criteria for a day treatment program. Those patients
who are medically unstable or who are so impaired that they cannot
benefit from day to day treatment may be excluded.
This program operates for 5 (Five) hours per day, Monday through
Friday of each week.
The Areas of Care and Service Providers match the Adult CDIOP
4.2.5 Adolescent Chemical Dependency Intensive Outpatient
Program
This program is designed for the treatment of patients up to the age of
18 with a primary diagnosis of alcohol and/or drug dependency who
meet the criteria for a medically-supervised intensive outpatient
treatment. Those patients who are medically unstable or who are so
impaired that they cannot benefit from outpatient treatment may be
excluded.
The Intensive Outpatient Program is in operation for three (3) hours per
day, Monday through Friday of each week.
The Areas of Care and Service Providers match the Adult CDIOP.
4.2.6 Adolescent Chemical Dependency Low Intensity Outpatient
Program
This program is designed for the treatment of patients up to 18 years of
age with a primary diagnosis of alcohol and/or drug dependency who
have successfully benefited from Intensive Outpatient Services.
Patients may receive three (3) to six (6) hours of programming per
week.
Areas of Care
lecture
group therapy
psychoeducation
Service Providers
LAC
LAC
LSW
Page 12 of 37
5.0
SERVICES
5.1
Needs Assessment Screening and Intake
Prairie accepts referrals from the professional community (physicians,
courts, community agencies, education systems, psychologists and
counselors), as well as by patients, or their supports. Intake screening
and evaluations are performed by qualified Needs Assessment
counselors or by a member of the clinical supervisory staff, Social
Services staff, registered nurse or active member of the Medical Staff,
24 hours per day, seven days per week. The individual is advised of
the program structure at the time of the evaluation, together with a
recommendation for the appropriate level of treatment according to
admission criteria and physician recommendation.
Financial
information is provided. If admission criteria is not met, or if PRAIRIE
does not offer a program to meet the patient's needs,
recommendations are made for assistance available elsewhere in the
community. As needed, provision for a safe transfer to an accepting
facility and physician will be arranged.
Admission to an inpatient program may be voluntary or court-ordered.
Patients are admitted to inpatient and partial hospitalization under
the care of a psychiatrist. Day treatment and Intensive outpatient
programs are under the supervision of a psychiatrist.
5.2
Admission Process
5.2.1 Inpatient and Partial Hospitalization Programs:
Upon receipt of physician's orders and signed consent for
treatment, the patient meeting admission criteria will be
admitted to the appropriate unit/program.
Partial
hospitalization patients will be instructed upon when to arrive at
next program day, if not in progress. An initial assessment will be
completed by a registered nurse. The physician's admission
orders and the nursing assessment then guide the initial
treatment plan.
The patient's family or support persons, if available, will be
interviewed by a member of the staff to obtain collateral family
history. The unit program will be explained to the patient and
Page 13 of 37
family and a copy of the program handbook will be provided.
The patient and belongings will be searched for unsafe items.
All dangerous items will be secured, labeled and placed for
safekeeping on the unit if not taken home by the family. The
patient will be oriented to the unit to which he is admitted,
including introductions to staff and peers, and the patient's
rights explained. The patient will be introduced into the
unit/program activity in progress at the time of admission, as
appropriate.
5.2.2 MI Day Treatment
For direct admission to the MI Day Treatment program, patients
are assessed by a Needs Assessment counselor. If the individual
meets the criteria for the program and requires this level of
care, the Needs Assessment counselor facilitates obtaining of
the physician's admission order, schedules start date for
programming, and schedules a psychiatric evaluation (by
psychiatrist or psychiatric nurse practitioner) to be completed
on or before the first day of treatment. If the patient is stepping
down from a higher level of care, the discharging physician
order for the referral to MI Day Treatment. The psychiatric
evaluation from the higher level of care will be copied and
placed in the patient's MI Day Treatment chart. On the first
treatment day, the program BHT will meet with the new patient
and review the schedule and orientation materials. The BHT will
also schedule the nursing assessment for the first day of
treatment. OT and SW assessments are completed within the
first 4 days of treatment. RN will complete health screening
within 3 treatment days.
5.2.3 Chemical Dependency Day Treatment
For a direct admission to the CD Day Treatment program,
patients are assessed by a Needs Assessment counselor and
a Licensed Addiction Counselor(LAC). If the individual meets
the criteria for the program and requires this level of care, the
Needs Assessment counselor coordinates the admission
process by the pre-certification of benefits in coordination
with Utilization Review, schedules a Nursing Assessment, and
sets a start date. If the individual is stepping down from a
higher level of care, the discharging physician will order for
referral to CD Day Treatment. The psychiatric evaluation and
other consults from the higher level of care will be copied by
Page 14 of 37
Medical Records and placed in the patient's CD Day
Treatment chart. On the start date the LAC or CDBHT will
meet with the individual and they are given all required
program material. The LAC develops the initial treatment
plan and with input from the Social Worker prepares the
treatment plan for a weekly review with the treatment team.
5.2.3 Chemical Dependency Intensive Outpatient
For a direct admission to CDIOP, individuals are assessed by a
Needs Assessment counselor and a Licensed Addiction
Counselor (LAC). If the individual meets the criteria for the
program and requires this level of care, the Needs
Assessment counselor coordinates the admission process by
the pre-certification of benefits in coordination with Utilization
Review, scheduling a Nursing Assessment, and sets a start
date. If the individual is stepping down from a higher level of
care this is coordinated between the treatment team, and
the discharging physician will order the referral to CDIOP. The
psychiatric evaluation and other consults from the higher
level of care will be copied by Medical Records and placed
in the patient's CDIOP chart. On the start date the LAC or
CDBHT will meet with the individual and they are given all
required program material. The LAC develops the initial
treatment plan and with input from the Social Worker
prepares the treatment plan for review with the treatment
team every two weeks.
5.2.4 Chemical Dependency Low Intensive Outpatient
For a direct admission to CDLIOP, individuals are assessed by
a Needs Assessment counselor and a Licensed Addiction
Counselor (LAC). If the individual meets the criteria for the
program and requires this level of care, the Needs
Assessment counselor coordinates the admission process by
the pre-certification of benefits in coordination with Utilization
Review, scheduling a Nursing Assessment, and sets a start
date. If the individual is stepping down from a higher level of
care this is coordinated between the treatment team, and
the discharging physician will write the order for admission to
CDLIOP. The psychiatric evaluation and other consults from
the higher level of care will be copied by Medical Records
and placed in the patient's CDLIOP chart. On the start date
the LAC or CDBHT will meet with the individual and they are
Page 15 of 37
given all required program material. The LAC develops the
initial treatment plan and with input from the Social Worker
prepares the treatment plan for review with the treatment
team once a month.
5.2.5 Intensive Outpatient Services:
Upon receipt of signed consent for treatment, the patient
meeting admission criteria will be admitted to the program and
scheduled for attendance at the next treatment day or
provided appointment information.
The therapist will complete a health screening and collect key
medical information. This information, along with the initial
needs assessment will be the basis for the treatment plan. If
indicated, the patient's family will be interviewed by the
therapist to obtain collateral family information.
The patient will receive an orientation to the therapy
expectations and physical layout and patient rights explained.
A copy of the patient handbook or information sheet will be
provided.
5.3
Assessment and Evaluation Procedures
Assessment of all patients begins on admission and is integral to the
treatment process. Treatment planning is individualized according to
individual needs identified through assessments. Primary assessments
include the following:
5.3.1 Inpatient
Psychiatric Evaluation: Performed by the attending psychiatrist
within 24 hours of admission. Includes a history of the present
disorder, brief psychiatric history, including history of substance
abuse, brief family history, brief medical history, mental status
exam, diagnostic impression, strengths and weaknesses, and
initial plan of care.
Medical History and Physical: Performed by the consulting
physician or Physician’s Assistant within 24 hours of admission.
Includes history of previous medical problems, present illness,
family medical history and review of systems and physical
examination.
Page 16 of 37
Nursing Assessment: Performed by a registered nurse within 8
hours of admission and includes the patient's physical/mental
health, a nutritional screening, assessment for pain, potential for
safety concerns, mental status exam and immunization status
for children/adolescents. Additional age-specific assessments
will be conducted on all geriatric, children, and adolescents.
The nurse initiates the preliminary treatment plan based upon
findings of the assessment.
Psychosocial History: Performed with the patient and, when
possible, family members/ significant others by Social Services
staff within 72 hours of admission and includes a complete
family history, interpersonal relationships, medical/psychiatric
history, ethnic/cultural and religious issues affecting treatment,
abuse history, discharge planning and an integrated summary.
Spiritual Assessment: Administered by an RN or LPN within 24
hours of admission and includes the patient’s spiritual history,
and if requested, the need for a chaplain’s visit and/or
contacting the patient’s own clergy/spiritual leaders.
Occupational/Activity Therapy Assessment: Performed by a
licensed/certified occupational therapist within 72 hours of
admission.
Patient/Family Educational Learning Assessment: Performed by
the Registered Nurse at the time of the nursing assessment,
documented and includes information on any limitations or
disabilities that may impact learning ability.
5.3.2 Partial Hospitalization Program:
Psychiatric Evaluation: Performed by the attending psychiatrist
within or 3 treatment days of admission. Includes a history of
the present disorder, brief psychiatric history, including history of
substance abuse, brief family history, brief medical history,
mental status exam, diagnostic impression, strengths and
weaknesses, and initial plan of care.
Medical History and Physical: Following review of the Nursing
Assessment, the physician may order a Medical History and
Physical. The H&P shall be completed the first day of treatment
for patients admitted directly from an inpatient service, the
current physical examination may suffice(if conducted within
Page 17 of 37
the previous 30 days). The physical examination is reviewed,
updated, approved, and recorded as acceptable by the
responsible physician for PHP.
Nursing Assessment: Performed by a registered nurse within 8
hours of admission and includes the patient's physical/mental
health, a nutritional screening, and immunization status for
children/adolescents. Additional age-specific assessments will
be conducted on all geriatric, children, and adolescents. The
nurse initiates the preliminary treatment plan based upon
findings of the assessment.
Psychosocial History: Performed with the patient and, when
possible, family members/ significant others by Social Services
staff within 5 days of admission and includes a complete family
history, interpersonal relationships, medical/psychiatric history,
ethnic/cultural and religious issues affecting treatment, abuse
history, discharge planning and an integrated summary.
Spiritual Assessment: Administered by an RN or LPN within 24
hours of admission and includes the patient’s spiritual history,
and if requested, the need for a chaplain’s visit and/or
contacting the patient’s own clergy/spiritual leaders.
Occupational/Activity Therapy Assessment: Performed by a
licensed/certified activities therapist within 5 days of admission.
Patient/Family Educational Learning Assessment: Performed by
the Registered Nurse at the time of the nursing assessment,
documented and includes information on any limitations or
disabilities that may impact learning ability.
Outpatient Summary List: Completed by the Registered Nurse
on admission and includes known significant medical diagnoses
and conditions, known adverse and allergic drug reactions,
medications known to be prescribed for or used by the patient,
and any known significant operative or invasive procedures.
5.3.3 Intensive Outpatient
Comprehensive Needs Assessment: Completed in Needs
Assessment and Referral Center or by therapist and provides
information on presenting symptomatology, and key social and
Page 18 of 37
risk factors to provide a baseline of information for treatment
planning.
Health Screening Form: Completed by the therapist and
reviewed by the physician overseeing the program. Includes
information on current health status and medical issues.
Outpatient Summary List: Completed by the therapist/designee
no later that the third visit and includes known significant
medical diagnoses and conditions, known adverse and allergic
drug reactions, medications known to be prescribed for or used
by the patient, and any known significant operative or invasive
procedures.
5.3.4 Additional Assessments:
As indicated by patient need, physician and treatment team
assessment, the following assessments may be provided:
Educational Assessment: As indicated by length of stay, or
special need an education assessment may be performed on
children and adolescent patients by a certified teacher with
input from the home school. Includes grade level, history, test
results, strengths, weaknesses and interventions. Completed
within 3 days of admission/physician's order or within 3
Treatment Days.
Psychological Assessment: Performed by a psychologist as
ordered by the physician to assist the treatment team in
understanding the nature of the illness.
May includes
personality, intellectual and neuropsychological testing as
ordered by the physician.
Nutrition Assessment: Performed by the Registered Dietitian
within 48 hours or within 2 Treatment Days of a written order by
the physician or notification by nursing that nutritional screening
criteria established by the medical staff has been met. Includes
dietary needs, assessment of lab results, preferences, habits,
and recommendations.
Page 19 of 37
Drug and Alcohol Assessment: Performed when indicated by
the Chemical Dependency Counselor within 72 hours or within 2
Treatment days of order or admission to program. Includes
history of alcohol/drug use, history of physical problems
associated with dependence, use of alcohol and other drugs
by family members, spiritual orientation, types of previous
treatment and responses to that treatment, history of physical or
sexual abuse as the abuser or the abused, and sexual
orientation.
.
5.4
Other Assessments: Laboratory, radiology, MRI, EKG/EEG, CT
Scan, vocational, rehabilitation, spiritual and other specialized
consultations such as speech, language and hearing are
ordered on an individualized basis to assure optimal utilization of
resources.
Service Delivery Methods
Individualized treatment is based on the findings of the completed
assessments and is provided by a multi- disciplinary team of
professional staff. This team includes, but is not limited to, the
psychiatrist, psychologist, nursing staff, social services staff, chaplains,
dietitian, occupational and activity therapist(s) and educational staff.
The primary objective of the treatment team is the assessment,
treatment and rehabilitation of the patient in an environment that
promotes positive behavioral change. This may include, but is not
limited to, the following therapeutic modalities:
5.4.1 Individual Therapy: The purpose of individual therapy is to assist
the patient to gain a dynamic cognitive or supportive
understanding of emotional and/or behavioral problems that
have led to his present life situation. The goal of individual
therapy is to help the patient attain a more appropriate and
rewarding psychosocial adjustment to facilitate psychological
comfort, goals and aspirations. Individual therapy is conducted
by a qualified counselor, psychiatrist, therapist or social worker,
who may or may not also act as the patient's case manager.
5.4.2 Group Therapy: The group process is utilized to help alleviate
interpersonal
and
social
dysfunction,
to
develop
communication and relationship skills, to develop identity with
allegiance to a group of peers, to increase understanding of
illness and coping options, and to foster pro-treatment attitudes
Page 20 of 37
and behaviors. Other goals of the group include development
of group cohesion, reality testing within age- appropriate limits,
inter-personal learning, role communication, a beginning ability
to identify internal and external behaviors and developing
insight into the interrelationships between internalized feelings
and externalized behavior.
5.4.3 Family Therapy: Implicit in the treatment philosophy is the
importance of parental and family involvement in the total
treatment program. A dysfunctional family system is usually a
significant aspect of the total pathology of the identified
patient. The family is involved in treatment to address the
pertinent issues within the family system. The goal is to restore or
maintain as functional and healthy a family system as possible
to provide for the continued emotional growth and
development and well- being of the identified patient and
other family members.
5.4.4 Activity Therapy: Assists the patient in working on psychological
and physical development through involvement in structured
and unstructured activities. The patient is assessed for level of
functioning and therapeutic needs are identified.
5.4.5 Educational Therapy: Provided by certified teachers, employed
by the Fargo School District, or other qualified staff who assess
each patient's educational needs. Learning opportunities,
when clinically appropriate, are provided to enable each study
to stay current with missed schoolwork and to remediate
specific academic deficiencies. Department staff work closely
with the patient's home school at admission and strive to
continue the course work of the student through on-going
communication with the home school.
5.4.6 Milieu Therapy: Provides a predictable, structured and safe
treatment setting. Uniform and consistent limits, set by the
clinical staff, assist in the management of behaviorally
expressed feelings. Special emphasis is placed on the learning
of appropriate behavior. Clinical staff act as role models and
help patients through daily routines such as mealtimes and
bedtime. Interpersonal skills in building and maintaining
appropriate relationships with peers and authority figures are
stressed. Patients and treatment staff meet in community
sessions in all treatment programs.
Page 21 of 37
The adolescent and child programs utilize a level system in order
to promote a clear reflection of the patient's progress and
provide specific feedback to the patient about how effectively
he is handling personal responsibility.
5.4.7 Spirituality: Provided by professional chaplains. Examples of
programming include individual meetings, daily “Thought for
the Day” announcements, adult morning reflection, adolescent
and child evening reflection groups, optional worship services,
group therapy with topics on the nature of spirituality,
forgiveness,
guilt/shame,
grief,
serenity,
empowerment/communication, and intimacy. In these sessions,
the chaplains explore with patient's their spiritual histories and
the areas of spiritual injury, as well as assist in developing healthy
attitudes and practices with the patients.
5.4.8 Therapy Groups: Patients are involved in specific therapy
groups according to their individual needs and level of care.
These may include:
Child and Adolescent Programs
Process Group - facilitated by Master's level or PhD level
therapists focuses primarily on the process of the interaction
between group members and therapist rather than the content.
This focus on process helps the therapist to identify recurrent
aspects of the patients relationship with others and lead the
participants toward interpersonal learning, insight and support.
Didactic or Psychoeducation Group - may include drug
awareness and education, assertive skills, coping skills, sex
education, suicide education and prevention, drug and
alcohol awareness, problem solving, family issues and sexual
abuse; facilitated by the primary therapist, case manager or
certified substance abuse counselor.
Activity Therapy - is provided by a licensed recreation therapist
to provide opportunities for leisure counseling and develop
effective life skills.
Family Therapy - facilitated as indicated by the case manager,
social worker, therapist, psychologist or attending psychiatrist to
foster communication skills, cohesion and adaptability between
the youth and his caretakers.
Page 22 of 37
Daily Community - facilitated daily by unit staff to enhance the
patient's ability to function in social settings with both adults and
peers. Morning and/or afternoon community meetings are
utilized to establish and evaluate goals set by each patient in
the acute programs. Community is held each session for the
PHP and IOP programs.
Spirituality: Provided by professional chaplains. Examples of
programming include individual meetings, daily “Thought for
the Day” announcements, adult morning reflection, adolescent
and child evening reflection groups, optional worship services,
group therapy with topics on the nature of spirituality,
forgiveness,
guilt/shame,
grief,
serenity,
empowerment/communication, and intimacy. In these sessions,
the chaplains explore with patient's their spiritual histories and
the areas of spiritual injury, as well as assist in developing healthy
attitudes and practices with the patients.
Adult Chemical Dependency Programs
Daily Community- facilitated daily by unit staff to enhance the
patient's ability to function in social settings with both adults and
peers. Morning and/or afternoon community meetings are
utilized to establish and evaluate goals set by each patient in
the acute program. Community is held each session for the PHP
and IOP programs.
12-Step - in-depth reading and discussion of the "Big Book" of
Alcoholics Anonymous. Individual reading and written work may
take place during this period depending on the needs of the
group.
Lecture -Facilitated by a nurse, social worker, physician,
chaplain or counselor, lecture topics include medication
education, spiritual issues, grief, humor, self-talk and self-help.
Self-help Support Group - AA, NA, AL- ANON, ACOA, etc., are
support groups for the patient and family dealing with various
addictive disease issues. These meetings are usually open to the
general public and are led by a volunteer from the recovering
community in various community locations.
Page 23 of 37
Process Group - These groups provide an opportunity for
patients to give input into their treatment plan, receive
feedback from the clinical team and participate in structured
activities related to various didactic groups. Peer review may
also provide feedback about patient progress in the various
programs.
Spirituality – Provided by professional chaplains. Examples of
programming include individual meetings, daily “Thought for
the Day” announcements, adult morning reflection groups,
optional worship services, and group therapy with topics on the
nature of spirituality, forgiveness, guilt/shame, grief, serenity,
empowerment/communication, intimacy, and groups dealing
with Steps One through Five of the 12 Step program. In these
sessions, the chaplains explore with patient’s their spiritual
histories and the areas of spiritual injury, as well as assist in
developing healthy attitudes and practices with the patients as
they further develop a relationship with their Higher Power. At
the patient’s requests, the chaplains will assist in connecting
patients with local clergy/spiritual leaders in hearing their fifth
steps.
Adult Treatment Program
Daily Community- facilitated daily by unit staff; community is
designed to enhance the patient's ability to function in social
settings with both staff and peers. Morning and /or afternoon
community meetings are utilized to establish and evaluate
goals set by each patient in the acute programs. Community is
held each session for PHP and IOP programs.
Lecture - Facilitated by a nurse, social worker, physician,
chaplain or counselor, lecture topics include medication
education, spiritual issues, grief, humor, self-talk and self-help.
Process Group - facilitated by Master's level or PhD level
therapists focuses primarily on the process of the interaction
between group members and therapist rather than the content.
This focus on process helps the therapist to identify recurrent
aspects of the patients relationship with others and lead the
participants toward interpersonal learning, insight and support..
Relaxation Group - Different types of relaxation training, such as
guided imagery, progressive muscle relaxation and breathing
Page 24 of 37
exercises are taught in a group setting. Lifestyle changes
needed to alleviate stress will be identified.
Activity Therapy Group - Facilitated by a licensed Recreation
Therapist to provide opportunities for leisure counseling and
develop effective life skills.
Psychoeducational Groups - facilitated by Social Workers,
therapists or nursing staff, these groups provide specific
information about health, wellness, diagnosis, coping skills or
discharge planning.
Spirituality: Provided by professional chaplains. Examples of
programming include individual meetings, daily “Thought for
the Day” announcements, adult morning reflection groups,
optional worship services, and group therapy with topics on the
nature of spirituality, forgiveness, guilt/shame, grief, serenity,
empowerment/communication and intimacy. In these sessions,
the chaplains explore with patients their spiritual histories and
the areas of spiritual injury, as well as assist in developing healthy
attitudes and practices with patients.
5.4.8 Pharmacotherapy
Can be initiated for the treatment of severe emotional
disturbance or chemical abuse/addiction upon written order of
the attending physician. The use of medication is judiciously
individualized for each patient. The Pharmacy and Therapeutics
Function of the medical staff monitors utilization through
ongoing monitoring and evaluation activities, which may
include peer review.
Medications may be administered only by physicians, registered
nurses, licensed practical nurses in the inpatient, residential,
partial hospitalization. Licensed nurses may accept verbal or
telephone orders from a qualified physician. Any such orders
must be countersigned by the physician within the time frame
specified in the Medical Staff Rules and Regulations.
5.4.9 Treatment Planning
Each program has a multidisciplinary approach to treatment
planning. Those involved in the treatment planning process,
based on the program, may include the patient's physician,
Page 25 of 37
nursing staff, social workers, psychologists, counselors, , licensed
addiction counselors, behavioral health technicians, chaplains,
teachers and activity therapists. The team is responsible for
development of the individualized treatment plan and the
review and evaluation of ongoing treatment.
Preliminary Treatment Plan - The preliminary treatment plan is
initiated upon admission by the registered nurse, physician or
designee. It is based on the intake assessment, nursing
assessment and physician's orders. It includes the following:
Identification of initial problems, symptomatic behavior of
the problem and assessment of the cause of the
problem.
Goals of treatment.
Measurable short-term objectives based on the goals of
treatment.
Therapeutic approaches (interventions) to be used with
the patient.
Accountable individual or department.
Initial Patient Assignments
Master Treatment Plan - The master treatment plan is formalized
no later than 3 days after admission for acute care, within 5
days for the PHP and by the fifth session in IOP. The treatment
plan is a reflection of our philosophy of treatment and reflects
the interdisciplinary input and collaboration of all team
members. It includes the following:
Identification of physical, psychological and social
problems the patient is experiencing. The process of
identifying and agreeing upon the three major problem
areas (target behaviors) to be addressed in treatment
occur as a result of the social worker meeting with the
patient and family. The target behaviors are then rated
by the patient and/or parents, in terms of severity, at the
time of identification and again at discharge. Coping
mechanisms for each of the target behaviors are also
agreed upon during this initial assessment phase. Once
Page 26 of 37
treatment is implemented, the team evaluates changes
in the target behaviors on a weekly basis as part of the
treatment review process.
The treatment team, the patient and the family also
complete a variety of assessments of functioning tools.
The psychiatrist completes the Global Assessment of
Functioning (GAF). The RN facilitates the patient
completion of the Admission Patient Depression
Inventory. Social Work completes the Global Assessment
of Relationship Functioning (GARF), Social Support Scale
and assist parents with the Parent Rated Global
Assessment Scale (PGAS).These tools allow the patient,
family and treatment team to regularly assess areas of
improvement and serve to keep the treatment team
focused on those areas where improvement is still
essential for successful discharge. At the time of
discharge patient, parent, if applicable, and staff again
complete the various assessment of functioning tools as a
way of evaluating the overall success of treatment.
Achievable long-term goals of treatment stated in
behavioral terms.
Measurable short-term goals stated in behavioral terms
that will reflect progress toward the goal achievement.
Therapeutic approaches (interventions) used by each
discipline to assist the patient in meeting the target area
treatment goals.
The individual or discipline accountable for assisting the
patient with therapeutic approaches.
Page 27 of 37
Patient progress in meeting the treatment plan goals is
documented in the progress notes and is reflected on the
treatment plan updates based on scoring the change in
target problem severity using a scale from 0-4.
The nursing staff and case manager, or therapist in the
outpatient settings, are responsible for noting the treatment
method, as well as decisions and revisions of the treatment plan
by the treatment team, both at meetings and on an on-going
basis.
The patient, and family when appropriate, is encouraged to
participate in the treatment planning process by providing input
and acknowledging agreement with the plan in writing.
Conflicts in care decisions and resolutions of dilemmas about
care decisions are addressed cooperatively by the team
members and the patient and/or family.
Treatment plans are reassessed by the team on a weekly basis
and revised as needed.
5.4.10 Discharge and Post-Discharge Planning Process
During the remainder of treatment, the patient's progress and
the continuing applicability of the on-going treatment plan are
reviewed at regular intervals. There are both formal and
informal mechanisms to accomplish this. The treatment plan will
be reviewed, revised or refined during multi disciplinary team
reviews.
Consideration of discharge plans for the patient is an integral
part of the treatment planning process. Discharge planning
begins at the point of admission and continues throughout
treatment as a multi disciplinary effort. Discharge criteria are
established during the treatment planning conference and
reviewed and revised as necessary during treatment. Possible
discharge dates and post-treatment goals are discussed as the
patient moves toward achieving the criteria set for discharge.
The psychiatrist and social worker/therapist coordinate the
discharge arrangements with the patient and family. Certain
dispositions/discharge needs may be considered for the
patient, including a return to the home, placement in a group
Page 28 of 37
or foster home or an institutional placement, partial
hospitalization, outpatient therapy, community programs and
support groups, transportation, medical follow-up, and
aftercare programs.
The facility ensures that appropriate patient care and clinical
information is exchanged when patients are referred,
transferred, or discharged to include: reason for transfer, referral
or discharge, patient's physical and psychosocial status,
summary of care provided and progress toward goals, and
community resources and referrals provided to the patient.
Transitions between levels of care are smooth and coordinated
involving communication to facilitate family support, social
work, nursing care, consultations, and referrals.
5.4.11 Clinical Care Evaluation and Follow-up Clinical care evaluation of the patient is conducted by
on-going treatment review by the multi disciplinary team; by
concurrent review by utilization management staff and patient
care performance improvement monitors.
The Medical Director and medical staff evaluate selected
admissions; lengths of stay criteria and documentation.
Notification of appropriateness of admission, treatment and
length of stay is carried out according to approved criteria
related to the patient's severity of illness and the intensity of the
services provided.
5.5
Description of Clinical Services
5.5.1 Occupational Therapy/Activity Therapy - The OT/AT therapy
program provided for inpatient, residential and partial
hospitalization patients includes a variety of services to meet
the physical, social, cultural and recreational health
maintenance and rehabilitation needs of each patient. These
services assist in the formation and development of new
behavior patterns, problem-solving abilities and the
internalization of healthy adaptive responses to internal and
environmental stressors.
5.5.2 Community Education and Relations - Members of the
professional staff of PRAIRIE are active participants in an
on-going community education service developed to meet the
Page 29 of 37
needs of the professional community, as well as the lay public.
Those staff members with expertise in public speaking, teaching
and/or group facilitating work closely with the Community
Liaisons, who are responsible for the coordination of the
community education program.
5.5.3 Consultations and Referrals - The attending medical staff is
responsible for requesting consultations when indicated.
Members of the consulting staff are used for these services
unless the services are not immediately available or additional
outside expert opinions are needed. A satisfactory consultation
includes examination of the patient and documentation of
findings and follow-up in the medical record.
5.5.4 Diagnostic Testing and Procedures – Prairie provides for limited
diagnostic tests and procedures within the facility. Other
diagnostic tests, including radiology, EEG, emergency and
laboratory services, are provided by contracted services.
5.5.5 Dietary Services - Dietary services are available to all patients
seven days a week with three meals per day during regularly
scheduled hours for all inpatients. Dietary services to PHP and
IOP will be program specific. Nutritious snacks are also
available in unit dining rooms/kitchens. The Dietary Services also
provides meals for staff who are responsible for direct patient
supervision.
Patients are served nutritionally balanced meals planned under
the supervision of a registered dietician and in accordance with
the written orders of the attending psychiatrist. Special
consideration is made in food preparation and appealing
presentation.
Individual patient food preferences and
nutritional needs are also taken into consideration. Consultation
and education for patients on special diets are provided by the
dietitian.
The Dietary Services provides services under the direction of the
food service manager with consultation and direction of a
dietitian.
5.5.7 Dental Services - On-site dental services are not available, but
emergency services are available as the need arises. Elective
dental services are provided by the patient's dentist on an
outpatient basis or by a qualified community dentist upon
Page 30 of 37
written physician order.
Transportation and dental service costs are the responsibility of
the patient.
5.5.8 Education Services - Education services are provided to children
and adolescents in a classroom or study room environment. For
most inpatients, educational assistance is provided in a tutorial
mode with a goal of maintaining the patients school level and
improving study skills. Patients with longer lengths of stay will
receive individualized instruction with certified teachers in small
classroom settings and if needed, a comprehensive evaluation
of abilities and aptitude, as well as an assessment for any
academic deficits or learning disabilities. An individualized
education plan may be implemented based upon patient
need, ability and the treatment plan.
5.5.9 Emergency Services - Emergency psychiatric and medical
services are provided by the medical staff 24 hours per day. A
written plan for management of medical and psychiatric
emergencies has been developed to provide emergency
services to those patients requiring immediate medical
evaluation and treatment for urgent conditions. The plan
includes, but is not limited to, the following:
Written agreements with Meritcare Health System and
Innovis Health Hospital provide for transfer of any patient
in need of treatment for an urgent medical condition
that cannot be treated by Prairie.
A contract with Fargo-Moorhead Ambulance Service for
transport of a patient when 911 is not necessary.
The attending psychiatrist or on-call psychiatrist shall
authorize the use of emergency services and secure an
accepting physician at the receiving facility.
The Registered Nurse and/or Needs Assessment Counselor
shall assure administrative approval from Prairie and the
receiving facility, assure that a Memorandum of Transfer is
completed, the accepting facility has been notified and
the patient's family or significant other has been informed
of the need for emergency treatment.
Page 31 of 37
5.5.10 Medical Services - Medical services may be provided by a
qualified physician or physician's assistant under the direction of
the admitting psychiatrist.
The consulting physician or
physician’s assistant is responsible for a complete medical
history and general physical examination, and a neurological
assessment. A laboratory work-up including a drug screen,
blood chemistry, and tuberculin skin test may be ordered. A
chest x-ray, HCG, HIV, pregnancy test, pelvic exam with Pap
smear and culture for venereal disease and/or other clinically
appropriate diagnostic tests will be provided as indicated from
the medical history and clinical evaluation. The physician is also
responsible for the diagnostic work-up and test evaluation of
any detected or suspected medical disorders, as well as their
clinical management. Qualified medical specialists may be
requested to consult on the care of any patient with specific
medical needs.
5.5.11 Nursing Services - Nursing care services are organized under the
direction of the Clinical/Nursing Services Director as defined in
the hospital plan for nursing care. Nursing care is provided by
registered nurses, licensed practical/vocational nurses, and
behavioral health technicians who are qualified by education
and experience to assume the responsibilities for patient care.
The primary goal of nursing service is to provide planned,
comprehensive, therapeutic, safe and consistent nursing care
24 hours a day, seven days a week.
Psychiatric nursing is a specialized area of professional nursing
practice, which employs theories of human behavior and
interpersonal relationships. One of the primary activities of
nursing staff is the establishment of a trusting, therapeutic
relationship with individual patients accomplished through daily,
consistent contact. Additional responsibilities of nursing staff
include, but are not limited to: providing therapeutic context
(milieu) concerned largely with the sociopsychological aspects
of the patient's environment; providing a positive model of
interpersonal relationships; providing opportunities for learning
about self and exploring patterns of interaction within a safe
environment; on-going patient assessment and observation;
support and education for self- care; proper nutrition and
appropriate sleep patterns; detection and care for somatic
Page 32 of 37
aspects of the patient's health problems, including responses to
medications and other treatments; providing assistance in
participating in therapeutic activities concerned with
improvement or recreational, occupational and social
competence; providing continuity of patient care from
admission to discharge; participating in planned and informal
group meetings to identify the process of interaction; and
active participation in the multi disciplinary treatment team in
cooperative planning for the implementation and evaluation of
patient care. The nursing staff maintains on-going contact with
the patient's family, as appropriate. Nursing services provided
will be defined according to the patient's level of care.
5.5.12 Psychiatric Services - Each program is directed by a board
certified or board eligible psychiatrist or addictionologist who is
responsible for the planning, supervision and implementation of
clinical services for patients. This physician is responsible for the
quality of the total treatment delivered to patients of the
program. The director works with other qualified physicians or
addictionologists who directly treat, supervise, participate in
management and/or staffing conferences and works in
conjunction with the multi disciplinary team responsible for the
patient's care.
The designated Physician Executive provides clinical supervision
for the program and clinical staff who render direct psychiatric
services to patients. Each attending psychiatrist or
addictionologist attends treatment planning meetings to
develop and update treatment plans of his patients
and is also responsible for the total medical management of the
patient. The designated Physician Executive is responsible
directly to the Medical Director.
5.5.13 Psychological Services - Psychologists may function as members
of the multi-disciplinary clinical team. They are licensed by the
State and credentialed through the medical staff privileging
process as licensed independent practitioners. Psychologists
contribute to the diagnostic, therapeutic and aftercare efforts
of patients and may be credentialed to perform the following
functions:
Individual, group or family therapy
Psychological testing
Assessment of patients in seclusion and/or restraint
Page 33 of 37
Psychological testing is performed upon written order of the
attending psychiatrist.
5.5.14 Social Services - Social workers assume a responsible role in the
delivery of clinical services as described elsewhere in this plan.
These services include but are not limited to assessment,
discharge planning, group therapy, family therapy, individual
therapy, and education. Clinical services are provided in
cooperation with and under supervision of an active medical
staff member who has ultimate responsibility for patient care.
The Social Services Department, which reports to the
Clinical/Nursing Services Director and Social Work Supervisor, is
an integral part of the overall function of the facility. Social
Services incorporate the overall goal of assisting the patient to
resolve personal conflicts to enable the patient to function
adequately and independently.
5.5.15 Speech, Language and Hearing - The detection of
abnormalities of speech, language and hearing are part of the
assessment by the consulting physician/PA and attending
psychiatrist. Comprehensive assessment and necessary
treatment for any abnormality by a qualified clinician will be
arranged upon written physician order.
5.5.16 Pharmacy Services - Pharmaceutical services are provided by a
licensed pharmacist through a contractual agreement. The
dispensing of medication is performed by the licensed
pharmacist.
Prairie stocks only Schedule II drugs. Any
out-of-formulary medication not stocked within the pharmacy is
obtained from the pharmacy service according to individual
patient need.
5.5.17 Physical Therapy - Physical therapy services are typically not
provided within the facility, but may be accessed upon written
physician order by referral to a local facility or provider with a
contractual agreement.
5.5.18 Vocational Services - Activities therapy staff provide screening
for vocational needs as appropriate.
Comprehensive
assessment is available through the State agency on an outpatient basis or by referral upon written physician order.
Page 34 of 37
5.5.19 Pastoral Services - A spiritual assessment is given to patients to
complete and is then reviewed by Prairie’s chaplains. As
indicated on the assessment, the chaplains will contact the
patient’s pastor/spiritual leader and/or conduct individual
visitation themselves.
Programming which is provided by Prairie St. John’s professional
chaplains include individual meetings, daily “Thought for the
day” announcements, adult morning reflection groups,
adolescent and child evening reflection groups, and group
therapy with topics on the nature of spirituality, forgiveness,
guilt/shame, grief, serenity, empowerment/communication,
intimacy and groups dealing with Steps One through Five of the
12 Step program. In these sessions, the chaplains explore with
patients their spiritual histories and the areas of spiritual injury, as
well as assist in developing healthy attitudes and practices with
the patients. Chaplains assist patients in connecting to local
clergy/spiritual leaders for 5th Steps and/or sacraments
celebrated within a parish/congregational community.
Regularly scheduled worship services are offered Sundays,
Wednesdays, Thursdays and holidays/holy days.
A chaplain is available 24/7. They are on-call after regular
business hours.
6.0 Behavior Management –The goal of behavior management is to help
patients learn to control their own behavior. Behavior Management includes a variety of techniques that assess, redirect and address patient
behavior.
All patients are informed of standards of behavior during orientation
by unit staff. All patients receive a copy of the unit expectations/rules.
These expectations are reinforced as needed in the Goals/Community
meetings, which occur two times daily and during scheduled
programming. Patients experiencing extreme difficulty within the
program may be placed on an individual plan that identifies the
unacceptable behaviors, the desired behaviors and the reward for
achievement.
Page 35 of 37
At the same time, specific programs include a daily point sheet that
assesses patient participation and behavior throughout the course of
treatment. It is completed on a daily basis, provides the patient with
immediate feedback and, when indicated, rewards. Finally, the
inpatient units utilize a level system reflecting specific patient privileges
based on functioning acuity level and behavior. A behavior
management plan is also designed to provide guidelines for the
management of psychiatric emergencies involving actual or
potentially aggressive or assaultive behavior by patients. The program
includes, but is not limited to the following:
6.1 Development of written policies and procedures for:
6.1.1 Identification of risk factors for aggressive or assaultive
behavior
6.1.2 Use of time-out, seclusion/restraint; and
6.1.3 Debriefing sessions to reinforce interpersonal support of
staff and appropriate techniques following a critical
incident.
6.2 Mandatory training in appropriate intervention techniques,
including seclusion/restraint, for all clinical staff and any other
employees who participate in such situations.
7.0
STAFFING
A.
General Staffing
Staffing levels and classification are determined by the patient acuity
system, census and individual patient needs. Additional staffing
includes all disciplines noted in the makeup of the interdisciplinary
treatment team and based on the scope of services offered in the
program.
B.
Nursing Staffing
Nursing care is prescribed, delegated and coordinated by registered
nurses. Members of nursing staff include registered nurses, licensed
practical/vocational nurses and behavioral health technicians.
Assignments for nursing care are made according to programmatic
and patient acuity needs as defined in the hospital plan for nursing
care.
Page 36 of 37
Adjustments for planned staffing are made daily by the
Clinical/Nursing Services Director or her designee based on the
patients' individual needs.
8.0
STAFF QUALIFICATIONS AND COMPETENCY
Prairie St. John’s actively maintains on-going processes to assure that only
qualified and competent staff provide patient care, administrative or
support services.
Facility employees are credentialed through an internal mechanism
supervised by the Human Resources Director. Each employee performs his
duties according to a criteria-based job description that reflects patient
age- and population-specific needs and defines required qualifications and
competency standards. A performance appraisal is conducted for each
employee after 60 and 90-days of employment and upon completion of the
probationary period and at least annually thereafter. Clinical staff are also
required to complete a competency assessment and orientation upon hire
and annually thereafter in selected areas to assure that on-going
competency requirements are met.
Credentialing for members of the medical staff and affiliate staff is provided
through the medical staff credentialing and privileging process for
appointment as previously noted. This process is defined in the Medical Staff
Credentialing Plan and Medical Staff Bylaws.
9.0
EVALUATION
Monitoring and evaluation of the effectiveness of patient care and support
services are maintained on an on-going basis through a well-defined
program for improving organizational performance.
The program
emphasizes the analysis of the appropriateness of care, evaluation of
problems and concerns identified, as well as opportunities for improvement
of services and patient care. These activities provide a mechanism to
effectively assure a comparable level of care for all patients.
This plan for provision of patient care is reviewed and revised as necessary,
but not less than annually. The following elements are taken into
consideration in conducting the annual review:
9.1
9.2
The facility's mission;
Strategic and budget planning process;
Page 37 of 37
9.3
9.4
9.5
9.6
9.7
Findings from performance improvement, risk management, utilization
review and other evaluation activities;
Changes inpatient care needs/community needs;
Patient requirements and implications for staffing;
Relevant information from staffing variance reports; and
Adequacy of staff recruitment and development activities.
Findings from the annual review will be reported to the Quality Management
Function, Medical Executive Committee and Board of Trustees.
APPROVED:
BOARD OF TRUSTEES
Stephen R. Setterberg, MD
Medical Director/Chair of Board of Trustees
Emmet M. Kenney, Jr., MD
Chief of Medical Staff
Marshall Korman
Chief Executive Officer
5/15/03
Date
5/15/03
Date
5/15/03
Date
Page 38 of 37