PERSONAL BEHAVIOURAL SUPPORT PLAN

Transcription

1 ECT PERSONAL BEHAVIOURAL SUPPORT PLAN NAME NHS NUMBER D.O.B WARD CONSULTANT P /05/1985 Apple Tree Dr Smith How I present on a good day: P is able to sit in main communal areas, staff on observations may be able to give P more space and freedom to stroll around. P has a good appetite and can hold onto his drinks. The content of P s comments is around football and snooker. P has a bright smiling face when he recognises staff. What helps me to keep Calm and engaged: Staff on my observations talk to me and are smiley and approachable. Staff are reassuring if I get confused or anxious. Staff remind me I can have a cup of tea and toast after ECT. I am offered regular cups of tea. I am prompted to use the bathroom regularly it makes me upset and anxious if I have an accident. Staff reassure me throughout the morning, walking over and during ECT processes. Things that make me feel; Upset/ Sad: P may be anxious and upset when being held, and not knowing the purpose. P Gets upset when he doesn t recognize the staff. P gets upset if he can t access the garden. Having injections Angry/Agitated: Lack of sleep or erratic sleep pattern When P has an accident this makes him anxious and agitated. When staff raises their voice or have a serious facial expression. If given mash potatoes P dislikes the taste. If he believes that staff are the Mafia and he is in prison Agitation when walking to ECT treatment

2 Physical Health risks: *Malnourishment, Sleep deprivation, exhaustion, physically frail due to this, further deterioration in mental health if ECT is not administered. TERTIARY INTERVENTION RISK; Prolonged struggle may potentially increase agitation, breathing difficulties and heart rate. Potential for damage to right arm and staff to make sure no higher than DMI level 2 holds to be used on his right arm. Post ECT pathway physical observations to be completed. THINGS I DO IF I START TO FEEL anxious, upset, agitated, angry: P paces around the ward P Makes comments about the mafia and staff being different people in the mafia. P has a fixed flat facial expression and may refuse to talk to staff. Waiting around for ECT treatment. PRIMARY INTERVENTIONS Staff on 2:1 observations to be mindful of redirecting P to a quieter area of the ward or garden. Prior to ECT ward stimulus must be reduced to a minimum for P. P should have staff on observation that he likes and feels safe with. In the morning prior to ECT P should be escorted by a minimum of three staff. P should be booked in as early as possible as he manages better having an early time. P to be offered reassurances of a nice cup of tea and buttered toast on return to the ward. or a ground walk and cigarette. Lidocaine (Topical cream) for local skin numbing (applied at least 20 minutes prior to intervention). THINGS I DO IF I HAVE MISSED USING MY PRIMARY INTERVENTIONS; Pacing more rapidly Increased volume Resistive to walking towards ECT Increased anxiety and therefore agitation SECONDARY INTERVENTIONS. For P to be escorted in clinical holds level 2 For staff to ring ahead and ensure ECT staff are ready and waiting so that P can go straight in with no waiting. Low level DMI intervention to be used staff the P knows to remain with him to offer reassurance and to distract and manage arms during administration of anaesthetic. THINGS I DO IF I HAVE MISSED USING MY SECONDARY INTERVENTIONS. If P misses or is too agitated to have ECT He will present with increasingly paranoid thoughts. At times P will attempt to look through peer s bedroom windows, entering peers bedrooms, staring at staff and peers, swearing at staff and peers. P may be anxious and upset when being held furthering his confusion. TERIARY INTERVENTIONS: If P has managed to attend ECT but becomes distressed when laying down. Staff will use below DMI intervention to safely administer ECT P will be in a Supine position while on a bed A maximum of 4 to 5 staff are required to support P There will be two members of staff one on each arm holding P using a Trust approved principle, Staff on the right arm to support the shoulder using a cupped hand to not apply pressure but to prevent P from sitting upright, also as P s arm is bent cover the elbow/arm with the soft part of

3 your arm mirroring the position and using P body to support his arm resting on his tummy to a maximum of level 2. Staff on the left arm are to use right hand to cup the shoulder to prevent P from sitting up (again no pressure to be applied) and the staffs left hand to be used to cover halfway down the fleshy part of the forearm so it is in a straight and facing up position (correct for clinical intervention of administering Anastasia). The third member of staff will manage P s head in a close proximity with their arm locked so as to minimise any pressure on P s head supporting with cupped hands. A fourth member is required to manage P s legs in the supine position as they would is lying on the floor. If Staff feel that P requires further support due to him being resistive a 5th member of staff can be used to support the shoulders of the staff member managing P s legs making sure they have a close proximity to the member of staff. If escalation continues due to any delays consideration to change of administration day may be required.

4 POST INCIDENT SUPPORT: WHAT MADE YOU FEEL; UPSET, ANGRY, AGGIATED? WHAT HELPED YOU TO CALM? WHAT COULD YOU HAVE DONE TO HELP US HELP YOU? HOW DO YOU FEEL PHYSICALLY WELL?

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