Essential Information Needed For Appropriate Care
of the Psychiatric Patient

By Sherri Perry, MS, APRN, FNP-BC
Clinical Director of Psychiatric Nursing, MediTelecare

Many Long-Term Care (LTC) facilities struggle with problems of polypharmacy, comorbidities, chronic diseases, underlying mental health conditions, and severe dementia with behavioral and psychological symptoms of dementia (BPSD) and physical aggression in their residents. Working together with the facility, MediTelecare can help relieve staff burden while giving these residents the best quality of life through talk therapy and suitable medications when needed.

Essential information is needed from the facility to assist the MediTelecare nurse practitioner in properly meeting the needs of the psychiatric patient. This includes a list of the most current medications prescribed, the resident behavior logs and recent psychotropic PRN (as needed) use.

Having access to a list of the most current medications prescribed is imperative. Most MediTelecare providers and telehealth assistants have access to the EMR in their assigned facilities. When this is not possible, an up-to-date list of medications for each resident must be reviewed by the provider before the patient can be seen. This medication list is important in making an educated assessment of what medications would be of most benefit as well as to evaluate any medications that may have interactions with any psychiatric medications prescribed.

Most LTC facilities implement the use of behavior logs for residents. These logs identify types of behaviors, including aggression or agitation and the number of days and episodes the resident is displaying the behaviors. Any adverse behaviors that warrant tracking for behavioral modification or future medication intervention should be recorded. Behavior logs are also very helpful to the provider and are similar to the commonly used Cohen-Mansfield agitation inventory (CMAI-short).1

Behavior logs combined with PRN medication use of the patient can give the nurse practitioner a picture of what behaviors the staff find challenging and how severe the behaviors may be. They also give an indication of whether non-pharmacological interventions may have positive effect on the behaviors or if medications are needed. Specific medications may be prescribed depending on the symptoms of the agitation or behaviors described in the logs. MediTelecare is dedicated to helping our patients maintain the best quality of life while also following CMS guidelines to reduce the psychotropic and antipsychotic rate in LTC facilities.2

Through compassionate witnessing, we can take the opportunity to integrate ethical principles in decision making with each patient. In being able to convey that we understand and empathize with the complex circumstances of the individual situation, we hope we can make a difference in each patient’s life.

References:

  1. American Psychological Association. (2018). Cohen-Mansfield Agitation Inventory Construct: Agitation related to cognitive impairment. Retrieved from: https://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/cohen-mansfield.aspx
  2. Centers for Medicare and Medicaid Services (CMS). (2014). Clinical Laboratory Improvement Amendments (CLIA). Retrieved from: https://www.cms.gov/Regulations-and-Guidance/Regulations-and-Guidance.html

 


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