Electro-Convulsive Therapy - Practice Guidance Note Source for ECT Integrated Care Pathway V03 V03 issued Issue 1 Apr 16 Issue 2 Jun 16 Planned review: Apr 2019 Responsible officer Sharron Robinson ECT-PGN-01 Author/Designation Responsible Officer / Designation Sharron Robinson Medical Director This Pathway contains all of the documentation (with the exception of MHA documents) that is required for a patient to receive a course of ECT within Northumberland, Tyne and Wear NHS Foundation Trust (the Trust/NTW). All the documentation is available on the ECT section of the Physical treatments part of RIO. For non-rio users the Pathway itself should be kept in the Other Prescribed Treatments section of the care records Section Content Page No: 1 Hadrian Clinic - Work-up Clinic (pre ECT assessment) 1 2 St George s Park - Work-up Clinic (pre ECT assessment) 3 3 Tranwell Unit - Work-up Clinic (pre ECT assessment) 4 4 Sunderland Work-up Clinic (pre ECT assessment) 6 Appendices listed separately to practice guidance note Document No: Description Issue Issue Date Review Date Appendix 1 ECT Work Up Check List and Clinic 1 Apr 16 Apr 19 Appendix 2 3Ms Examination Close Your eyes 1 Apr 16 Apr 19 Appendix 3 NTW Consent Form 1B 1 Apr 16 Apr 19 Appendix 4 NTW Consent Form 4b 1 Apr 16 Apr 19 Appendix 5 ECT Out-patient Care Plan 1 Apr 16 Apr 19 Appendix 6 ECT In-patient Care Plan 1 Apr 16 Apr 19 Appendix 7 Post anaesthetic information for patients receiving ECT 2 Jun 16 Apr 19 Appendix 8 Nursing Checklist for ECT patients 1 Apr 16 Apr 19 Appendix 9 ECT Documentation checklist 1 Apr 16 Apr 19 Appendix 10 Post ECT Checklist 1 Apr 16 Apr 19 Appendix 11 ECT Observation Chart 1 Apr 16 Apr 19 It is also recommended that all wards and departments obtain a copy of the Royal College of Psychiatrists ECT Handbook 2005 for reference
1. Hadrian Clinic - ECT work-up clinic - (pre ECT assessment) Procedure 1.1 Appointments Monday and Thursday - 9.00 am - 10.00 am Each appointment lasts for 20 minutes: there is a maximum of 3 patients per session. Please note that the service will be dependent on the resources available at each individual session. 1.2 Staff At least one ECT Nurse ECT Consultant Anaesthetist Ward/Department Junior Doctor/RMN ECT Junior Doctor 1.3 Venue ECT Department, Physical Treatment Centre, Hadrian Clinic 1.4 Aims of Work-Up Clinic To ensure patients are fully prepared for ECT in advance of treatment. The will provide a checking/advice service for referrers and pretreatment information provision/welcome for patients/carers. This will include advice on physical health issues, ensuring that correct documentation is completed and appropriate patient/carer information is provided 1.5 Referral System Appointments may be booked by phone to ECT Department at least one session prior to initial ECT Treatment. Patients should attend accompanied by a member of the referring team, and carer, if desired. All relevant documentation must be available. This must include any records of previous ECT treatments and the patient s medical records. If attendance at the clinic is not considered appropriate, the responsibility for all pre-ect investigations and patient information provision will fall to individual clinical teams N.B. If it is not possible for the patient to attend the work-up clinic, this document 1
1.6 Procedure Book appointment for Work-Up Clinic Patient to attend with carer and/or member of ward/department team wherever possible Complete referral details as denoted on ECT work-up checklist Notes (if paper records still in use) and medicine kardex to accompany patient to appointment. Any tests undertaken/arranged within Work-up Clinic will carry request to send results back to ward/department consultant Patient attends work up clinic appointment Patient is consented by ward team prior to initial ECT treatment 1.6.1 On completion of Work-Up Clinic, the patient s Consultant/Junior Doctor should subsequently arrange to see the patient to undertake consent process and if appropriate, booking of the first (and subsequent) ECT session(s) as per ECT pathway. 1.6.2 For queries contact Physical Treatment centre staff on Ext: 68663. 1.6.3 To book work-up clinic appointment ring/leave message on Ext: 68663 or 68664 1.7 Contact Details For contact details of ECT Consultant(s) and Anaesthetist(s) please contact the ECT Department in the first instance 1.8 All patients receiving ECT whether detained or not will be given written information. This information will be recorded on the work up checklist. Copies of NICE ECT guidance: Guidance on the use of Electroconvulsive Therapy TA 59 and Management of depression in Primary and Secondary care CG 90 1.10.4 and patient information booklets can be downloaded from: http://www.nice.org.uk/search/guidancesearchresults.jsp?searchtype=all&keywords=ect+l eaflets&startyearmonthgf=&endyearmonthgf 1.9 Copies of all information, care plans and check lists contained within this pack can be obtained from the ECT Department and documentation from NTW Physical treatments section of RIO. 2 St. George s Park Treatment Centre - ECT Work-Up Visit 2.1 Appointments Between Monday and Friday, at a mutually agreed time, Treatment Centre Staff will visit the client on the ward. 2.2 Staff Treatment Centre Nursing Staff. Anaesthetist when an anaesthetic opinion is required. 2
2.3 Venue Referring Ward, St George s Park. 2.4 Aims of Work-Up Visit To ensure clients are fully prepared for ECT in advance of treatment. To provide a checking/advice service for referrers and pre-treatment information provision. To offer clients the opportunity to visit the Treatment Centre prior to treatment should they choose to do so 2.5 Referral System N.B. Appointments may be booked by telephone or ECT Department at least one session prior to initial ECT Treatment (clients may be accompanied by their carer and/or a member of the referring team). All relevant documentation should be available If it is not possible for the patient to attend the work-up clinic, this document 2.6 Procedure Book appointment for work-up visit Client, carer and/or a member of the referral team to attend, whenever possible Complete referral details as denoted below Notes and medicine Kardex should be available for the appointment time Any test results undertaken or arranged at the work-up visit will be made available for the ward/department consultant Client consent to be completed by ward team prior to the initial ECT treatment 2.7 Upon completion of the work-up visit the client s Consultant/Junior Doctor should subsequently arrange to see the client to ascertain consent, if appropriate, booking the first and subsequent ECT sessions as per ECT pathway. 2.8 Contact: For contact details of ECT Consultant(s) and Anaesthetist(s) please contact the ECT Department in the first instance 2.9 Copies of NICE ECT guidance: Guidance on the use of Electroconvulsive Therapy TA 59 and Management of depression in Primary and Secondary care CG 90 1.10.4 and patient information booklets can be downloaded from www.nice.org.uk 2.10 Copies of all information, care plans and check lists contained within this pack can be obtained from the ECT Department and documentation from NTW Physical treatments section of RIO. 3
3 Tranwell Unit - ECT Work-Up Visit NB: It is not possible for the patient to be seen prior to ECT. This document can be used as a checklist to ensure that all points have been addressed 3.1 Appointments Monday and Friday 11.30am 3.2 Staff At least one ECT Nurse Anaesthetic Nurse Anaesthetist when an anaesthetic opinion is required 3.3 Referral System Ward staff/doctors should contact the ECT nurse at least one session prior to initial ECT treatment N.B. If it is not possible for the patient to attend the work-up clinic, this document 3.4 Venue The ECT staff will visit the patient on the ward or request the patient to attend the clinic 3.5 Aims of Work Up To ensure the patients are fully prepared for ECT in advance of treatment The ECT Team will provide a checking/advice service for referrers and pretreatment information for patients and carers. This will include advice on physical health issues, ensuring that correct documentation is completed and appropriate patient/carer information is provided. The patient and carers should be offered a visit to the department prior to treatment 3.6 Procedure ECT Staff will contact ward/patient to arrange an appointment on Ext. 6259 Patients should be seen with carer or member of ward team, whenever possible. All relevant documentation must be available includin notes and medicine Kardex, any tests undertaken and patients consent. Any tests undertaken by ECT work up will be placed in patients notes Upon completion of work up, the ECT staff will book the patients first (and subsequent) ECT session(s) as per ECT Pathway 4
3.7 Contact Details for ECT Clinical Tranwell Unit Location The ECT Department is situation on the ground floor of the Tranwell Unit 3.8 Clinical Times Monday 8.00 am - 12.30 pm Friday 8.00 am - 12.30 pm 3.9 For contact details of ECT Consultant(s) and Anaesthetist(s) please contact the ECT Department in the first instance 3.10 Copies of NICE ECT guidance: Guidance on the use of Electroconvulsive Therapy TA 59 and Management of depression in Primary and Secondary care CG 90 1.10.4 and patient information booklets can be downloaded from www.nice.org.uk 3.11 Copies of all information, care plans and check lists contained within this pack can be obtained from the ECT Department and documentation from NTW Physical treatments section of RIO. 5
4 Sunderland - ECT Service ECT Work-Up Visit 4.1 Sunderland Services are currently provided from the Tranwell Unit, Gateshead. Please refer all queries to this service. Notice of Sunderland ECT services resuming will be posted in the Chief Executive Bulletin when the new hospital is complete 4.2 Contact Details For contact details of ECT Consultant(s) and Anaesthetist(s) please contact the ECT Department in the first instance 4.3 Aims of Work-Up Clinic To ensure patients are fully prepared for ECT in advance of treatment To provide a checking/advice service for referrers and pre-treatment information provision To offer patients and relatives the opportunity to visit the ECT suite prior to treatment should they choose to do so and to meet the ECT nurse in an attempt to promote continuity of care To spend time with patients and relatives in order to provide support and information 4.4 Referral System Appointments may be made by contacting a member of the core ECT nursing team via Tranwell Unit, Gateshead, giving as much notice as is reasonable prior to the patient s first intended treatment day. Patients may be accompanied by their relative / carer and / or a member of the referring team. All relevant documentation should be available. N.B. If it is not possible for the patient to attend the work-up clinic, this document 4.5 Procedure Book appointment for Work-Up visit Patient / carer and / or member of the referral team to attend, wherever possible Notes and medicine Kardex should be available for the appointment time 4.6 Upon completion of Work-Up visit the patient s referring team should book the first and subsequent ECT session(s) as per ECT pathway. 6