Harbor:Psych patients - Revision history

Bchap23: /* Exodus Psychiatric Urgent Care */

2026-04-13T18:41:17Z

Exodus Psychiatric Urgent Care

← Older revision		Revision as of 18:41, 13 April 2026
Line 77:		Line 77:
	*** In the AED, the patient will be seen by the first available triage team.		*** In the AED, the patient will be seen by the first available triage team.
	*** If applicable, the original '''hold (5150 or 5585) documentation will accompany the patient.'''		*** If applicable, the original '''hold (5150 or 5585) documentation will accompany the patient.'''
	**** Please place the "5150 - 72 hours" order in Orchid ~~(Action on hold:~~ "Continued (no action)")		**** Please place the "5150 - 72 hours" order in Orchid and select "Continued (no action)" for the "Action on hold" field
	*** After handoff to the triage RN, Exodus staff will be released.		*** After handoff to the triage RN, Exodus staff will be released.

Bchap23: /* Exodus Psychiatric Urgent Care */

2026-04-13T18:40:02Z

Exodus Psychiatric Urgent Care

← Older revision		Revision as of 18:40, 13 April 2026
Line 77:		Line 77:
	*** In the AED, the patient will be seen by the first available triage team.		*** In the AED, the patient will be seen by the first available triage team.
	*** If applicable, the original '''hold (5150 or 5585) documentation will accompany the patient.'''		*** If applicable, the original '''hold (5150 or 5585) documentation will accompany the patient.'''
			**** Please place the "5150 - 72 hours" order in Orchid (Action on hold: "Continued (no action)")
	*** After handoff to the triage RN, Exodus staff will be released.		*** After handoff to the triage RN, Exodus staff will be released.

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	*** The clerk will print a “transfer packet” (do not need the EMTALA form)		*** The clerk will print a “transfer packet” (do not need the EMTALA form)
	**** Providers: try to complete the physician documentation so the Exodus staff can see what was medically addressed and view your MDM		**** Providers: try to complete the physician documentation so the Exodus staff can see what was medically addressed and view your MDM
			***** '''If the patient is on a 5150 hold, right click to cancel the "5150 - 72 hours" order and for the discontinue reason select "Hold continued at different service area"'''
	** Exodus staff (RN + security) will transport the patient back to Exodus.		** Exodus staff (RN + security) will transport the patient back to Exodus.
	** '''If there is any safety or elopement concern, or there is no longer space at Exodus, the patient will be transferred to the Psych ED.'''		** '''If there is any safety or elopement concern, or there is no longer space at Exodus, the patient will be transferred to the Psych ED.'''

Bchap23: /* Exodus Psychiatric Urgent Care */

2025-05-07T23:15:50Z

Exodus Psychiatric Urgent Care

← Older revision		Revision as of 23:15, 7 May 2025
Line 63:		Line 63:
	** Acute side is open 24/7		** Acute side is open 24/7
	** Outpt side (for med refills, etc) is open 24/7		** Outpt side (for med refills, etc) is open 24/7
			** Cannot take patients on a 5250

	* Initiating the transfer '''from Exodus to the AED or PED for clearance of an emergent medical condition''':		* Initiating the transfer '''from Exodus to the AED or PED for clearance of an emergent medical condition''':
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	* '''If there is ever an issue with the transfer back process, please call Dr. Chappell in real time.'''		* '''If there is ever an issue with the transfer back process, please call Dr. Chappell in real time.'''
	Dr. Chappell & Melissa Trejo (Exodus Director) 9-12-2022		Dr. Chappell & Melissa Trejo (Exodus Director) 9-12-2022


	==Psych ED Transfers to Med ED==		==Psych ED Transfers to Med ED==

Bchap23 at 22:57, 10 December 2024

2024-12-10T22:57:02Z

← Older revision		Revision as of 22:57, 10 December 2024
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	*** For psych admissions to '''psych inpatient unit''', must be cleared by Pulmonology or admitted to medicine		*** For psych admissions to '''psych inpatient unit''', must be cleared by Pulmonology or admitted to medicine

	=Covid Psych Patients=		==Covid Psych Patients==
	* '''COVID negative patients'''		* '''COVID negative patients'''
	** ED maintains primary management of the patient until physically transferred to psych		** ED maintains primary management of the patient until physically transferred to psych
Line 60:		Line 60:


	=Exodus Psychiatric Urgent Care=		==Exodus Psychiatric Urgent Care==
	** Acute side is open 24/7		** Acute side is open 24/7
	** Outpt side (for med refills, etc) is open 24/7		** Outpt side (for med refills, etc) is open 24/7
Line 93:		Line 93:
	** '''Any patients INITIALLY presenting to the Adult ED needing psychiatric evaluation should be sent to the Psych ED where they may then be triaged to Exodus.'''		** '''Any patients INITIALLY presenting to the Adult ED needing psychiatric evaluation should be sent to the Psych ED where they may then be triaged to Exodus.'''

			* '''If there is ever an issue with the transfer back process, please call Dr. Chappell in real time.'''
			Dr. Chappell & Melissa Trejo (Exodus Director) 9-12-2022

	* '''If there is even an issue with the transfer back process, please call Dr. Chappell in real time.'''


	~~Dr. Chappell & Melissa Trejo (Exodus Director) 9-12-2022~~

			==Psych ED Transfers to Med ED==
			* No current vital sign criteria
			* Transferred to med ED after MSE by psych resident

	[[Category:Admin]]		[[Category:Admin]]

Bchap23: /* Code Gold Process */

2024-10-30T19:13:11Z

Code Gold Process

← Older revision		Revision as of 19:13, 30 October 2024
Line 2:		Line 2:
	==Code Gold Process==		==Code Gold Process==
	* Prior to calling the code gold:		* Prior to calling the code gold:
			** The '''primary nurse should escalate to the resident/attending prior to calling a Code Gold''' unless there is an immediate safety concern.
	** The primary team should make attempts to de-escalate the patient.		** The primary team should make attempts to de-escalate the patient.
	** The '''primary nurse should escalate to the resident/attending prior to calling a Code Gold''' unless there is an immediate safety concern.		* Patients must be on a legal psychiatric hold, have documented '''lack of capacity''' by a provider (should be reassessed every 24 hours), or be actively trying to hurt themselves or others. In the absence of this criteria, patients have the right to disagree with our plan of care (AMA).
	* Patients must be on a legal psychiatric hold ~~or conservatorship (must have written proof)~~, have documented '''lack of capacity''' by a provider (should be reassessed every 24 hours), or be actively trying to hurt themselves or others. In the absence of this criteria, patients have the right to disagree with our plan of care (AMA).
	* The '''ED attending responsible for a given patient should respond to all Code Golds'''.		* The '''ED attending responsible for a given patient should respond to all Code Golds'''.

Bchap23: /* Code Gold Process */

2024-10-30T17:58:49Z

Code Gold Process

← Older revision		Revision as of 17:58, 30 October 2024
Line 11:		Line 11:
	** '''The Code Gold team leader will huddle with the primary RN and provider''' – why was the code called and what is the plan? This needs to be a conversation taking into account the safety and concerns of everyone.		** '''The Code Gold team leader will huddle with the primary RN and provider''' – why was the code called and what is the plan? This needs to be a conversation taking into account the safety and concerns of everyone.
	*** There may be a last opportunity for the physician and Code Gold leader to jointly attempt de-escalation		*** There may be a last opportunity for the physician and Code Gold leader to jointly attempt de-escalation
	'''Once the plan has been discussed with the team, the code gold team leader then assumes charge of the situation.''' * The goal of the code gold team is to use the least restrictive measures to safely work with the patients.		** '''Once the plan has been discussed with the team, the code gold team leader then assumes charge of the situation.'''
			*** The goal of the code gold team is to use the least restrictive measures to safely work with the patients.
	*** However, if attempts to de-escalate the patient do not prove successful they will place the patient in restraints to maintain patient and staff safety while allowing time for medications to have an effect.		*** However, if attempts to de-escalate the patient do not prove successful they will place the patient in restraints to maintain patient and staff safety while allowing time for medications to have an effect.
	*** In the event there is no provider at the bedside, the primary nurse can ask that the patient be placed in restraints but has the responsibility of obtaining a provider order within 1 hour. It is the primary RN's and provider's responsibility to document the behavior/justification and place the order. The code team only provides documentation of the code times and outcome.		*** In the event there is no provider at the bedside, the primary nurse can ask that the patient be placed in restraints but has the responsibility of obtaining a provider order within 1 hour. It is the primary RN's and provider's responsibility to document the behavior/justification and place the order. The code team only provides documentation of the code times and outcome.

Bchap23: /* Code Gold Process */

2024-10-30T17:55:37Z

Code Gold Process

← Older revision		Revision as of 17:55, 30 October 2024
Line 2:		Line 2:
	==Code Gold Process==		==Code Gold Process==
	* Prior to calling the code gold:		* Prior to calling the code gold:
			** The primary team should make attempts to de-escalate the patient.
	** The '''primary nurse should escalate to the resident/attending prior to calling a Code Gold''' unless there is an immediate safety concern.		** The '''primary nurse should escalate to the resident/attending prior to calling a Code Gold''' unless there is an immediate safety concern.
	** The primary team should make attempts to de-escalate the patient.
	* Patients must be on a legal psychiatric hold or conservatorship (must have written proof), have documented '''lack of capacity''' by a provider (should be reassessed every 24 hours), or be actively trying to hurt themselves or others. In the absence of this criteria, patients have the right to disagree with our plan of care (AMA).		* Patients must be on a legal psychiatric hold or conservatorship (must have written proof), have documented '''lack of capacity''' by a provider (should be reassessed every 24 hours), or be actively trying to hurt themselves or others. In the absence of this criteria, patients have the right to disagree with our plan of care (AMA).
	* The '''ED attending responsible for a given patient should respond to all Code Golds'''.		* The '''ED attending responsible for a given patient should respond to all Code Golds'''.

Bchap23: /* Code Gold Process */

2024-10-30T17:55:02Z

Code Gold Process

← Older revision		Revision as of 17:55, 30 October 2024
Line 2:		Line 2:
	==Code Gold Process==		==Code Gold Process==
	* Prior to calling the code gold:		* Prior to calling the code gold:
	** The primary nurse should escalate to the resident/attending prior to calling a Code Gold unless there is an immediate safety concern.		** The '''primary nurse should escalate to the resident/attending prior to calling a Code Gold''' unless there is an immediate safety concern.
	** The primary team should make attempts to de-escalate the patient.		** The primary team should make attempts to de-escalate the patient.
	* Patients must be on a legal psychiatric hold or conservatorship (must have written proof), have documented '''lack of capacity''' by a provider (should be reassessed every 24 hours), or be actively trying to hurt themselves or others. In the absence of this criteria, patients have the right to disagree with our plan of care (AMA).		* Patients must be on a legal psychiatric hold or conservatorship (must have written proof), have documented '''lack of capacity''' by a provider (should be reassessed every 24 hours), or be actively trying to hurt themselves or others. In the absence of this criteria, patients have the right to disagree with our plan of care (AMA).

Bchap23: /* Code Gold Process */

2024-10-30T17:41:19Z

Code Gold Process

← Older revision		Revision as of 17:41, 30 October 2024
Line 10:		Line 10:
	* When the code team arrives:		* When the code team arrives:
	** '''The Code Gold team leader will huddle with the primary RN and provider''' – why was the code called and what is the plan? This needs to be a conversation taking into account the safety and concerns of everyone.		** '''The Code Gold team leader will huddle with the primary RN and provider''' – why was the code called and what is the plan? This needs to be a conversation taking into account the safety and concerns of everyone.
			*** There may be a last opportunity for the physician and Code Gold leader to jointly attempt de-escalation
	'''Once the plan has been discussed with the team, the code gold team leader then assumes charge of the situation.''' * The goal of the code gold team is to use the least restrictive measures to safely work with the patients.		'''Once the plan has been discussed with the team, the code gold team leader then assumes charge of the situation.''' * The goal of the code gold team is to use the least restrictive measures to safely work with the patients.
	*** However, if attempts to de-escalate the patient do not prove successful they will place the patient in restraints to maintain patient and staff safety while allowing time for medications to have an effect.		*** However, if attempts to de-escalate the patient do not prove successful they will place the patient in restraints to maintain patient and staff safety while allowing time for medications to have an effect.
	*** In the event there is no provider at the bedside, the primary nurse can ask that the patient be placed in restraints but has the responsibility of obtaining a provider order within 1 hour. It is the primary RN's and provider's responsibility to document the behavior/justification and place the order. The code team only provides documentation of the code times and outcome.		*** In the event there is no provider at the bedside, the primary nurse can ask that the patient be placed in restraints but has the responsibility of obtaining a provider order within 1 hour. It is the primary RN's and provider's responsibility to document the behavior/justification and place the order. The code team only provides documentation of the code times and outcome.
	** In the event the provider or primary RN does not want the patient placed in restraints~~, please note that~~ the '''code team cannot stand-by while care is being provided''' as they all have their own patient care assignments to return to. It will then be the primary team's responsibility to manage the patients behavior. '''A code gold can be reactivated as needed.'''		** In the event the provider or primary RN does not want the patient placed in restraints:
			*** Note: the '''code team cannot stand-by while care is being provided''' as they all have their own patient care assignments to return to. It will then be the primary team's responsibility to manage the patients behavior.
			*** '''A code gold can be reactivated as needed.'''
			** If the patient is going to be placed in restraints:
			*** The team leader will direct his/her team and give specific assignments.
			*** The '''ED physicians and nurses should not get involved in the code gold process''' unless you are requested by the Code Gold leader. For safety purposes the code team should not move forward until all 5 members of the team have arrived with exception of immediate intervention to prevent harm. This is less of a problem in the ED as most staff have completed the AVADE III/CPI training and can assist as directed by the team leader. The team members come from our various psychiatric units and may take 2-7 minutes to respond. There is only one code gold team each day so more than one code gold call at a time will delay response further.
			** Do not ask that the patient be medicated prior to being restrained (not just held down). This is for the patient and staff safety. If the patient is restrained to the paramedic gurney, the code gold team leader will make the decision on how secure and safe he/she feels the situation is. The primary nurse will be responsible for medicating the patient.
			* It is a regulatory requirement that a debriefing occur immediately after the code situation has concluded. The primary RN and provider should be available to participate in the post debriefing.


	** The team leader will direct his/her team and give specific assignments. You should not get involved in the code gold process unless you are requested by the team leader. For safety purposes the code team should not move forward until all 5 members of the team have arrived with exception of immediate intervention to prevent harm. This is less of a problem in the ED as most staff have completed the AVADE III/CPI training and can assist as directed by the team leader. The team members come from our various psychiatric units and may take 2-7 minutes to respond. There is only one code gold team each day so more than one code gold call at a time will delay response further.		* If you are concerned that an agitated patient may become violent and feel you need support while determining capacity or hold criteria, '''you may call the Sheriffs at x64450 to briefly standby during your initial assessment''' (they are unable to stay for a prolonged time period).
	** Please do not ask that the patient be medicated prior to being restrained (not just held down). This is for the patient and staff safety. If the patient is restrained to the paramedic gurney, the code gold team leader will make the decision on how secure and safe he/she feels the situation is. The primary nurse will be responsible for medicating the patient.		** Always utilize de-escalation tactics such as '''active listening, a calm but firm voice, being down at eye level, providing personal space, offering choices, and providing food.'''
	** It is a regulatory requirement that a debriefing occur immediately after the code situation has concluded. The primary RN and provider should be available to participate in the post debriefing.		** At the same time, it is imperative you keep your distance and '''maintain situational awareness, preserving unimpeded access to the doorway for rapid escape.'''
			** Recognize that the presence of law enforcement may escalate or de-escalate the situation and adjust accordingly.
	* If you are concerned that an agitated patient may become violent and feel you need support while determining capacity or hold criteria, you may call the Sheriffs at x64450 to briefly standby during your initial assessment (they are unable to stay for a prolonged time period). Always utilize de-escalation tactics such as active listening, a calm but firm voice, being down at eye level, providing personal space, offering choices, and providing food. At the same time, it is imperative you keep your distance and maintain situational awareness, preserving unimpeded access to the doorway for rapid escape. Recognize that the presence of law enforcement may escalate or de-escalate the situation and adjust accordingly. Be aware that the Sheriffs are not legally allowed to touch or physically restrain a patient unless a crime has occurred (eg, someone has already been assaulted). If the patient’s behavior escalates, please call a Code Gold and document/timestamp the rationale and restraint orders as soon as possible.		** Be aware that the '''Sheriffs are not legally allowed to touch or physically restrain a patient unless a crime has occurred''' (eg, someone has already been assaulted).
			** If the patient’s behavior escalates, please call a Code Gold and document/timestamp the rationale and restraint orders as soon as possible.

	==ED Policy #6 (OSA)==		==ED Policy #6 (OSA)==

Bchap23: /* Code Gold Process */

2024-10-30T17:21:37Z

Code Gold Process

← Older revision		Revision as of 17:21, 30 October 2024
Line 1:		Line 1:

	==Code Gold Process==		==Code Gold Process==
	* Prior to calling the code gold, the primary team should make attempts to de-escalate the patient.		* Prior to calling the code gold:
	* Patients must be on a legal psychiatric hold or conservatorship (must have written proof), have documented lack of capacity by a provider (should be reassessed every 24 hours), or be actively trying to hurt themselves or others. In the absence of this criteria, patients have the right to disagree with our plan of care.		** The primary nurse should escalate to the resident/attending prior to calling a Code Gold unless there is an immediate safety concern.
	* The ED attending responsible for a given patient should respond to all Code Golds.		** The primary team should make attempts to de-escalate the patient.
			* Patients must be on a legal psychiatric hold or conservatorship (must have written proof), have documented '''lack of capacity''' by a provider (should be reassessed every 24 hours), or be actively trying to hurt themselves or others. In the absence of this criteria, patients have the right to disagree with our plan of care (AMA).
			* The '''ED attending responsible for a given patient should respond to all Code Golds'''.


	* When the code team arrives:		* When the code team arrives:
	** The team leader will ~~communicate~~ with the primary RN and provider – why was the code called and what is the plan. This needs to be a conversation taking into account the safety and concerns of everyone.		** '''The Code Gold team leader will huddle with the primary RN and provider''' – why was the code called and what is the plan? This needs to be a conversation taking into account the safety and concerns of everyone.
	** Once the plan has been discussed with the team, the code gold team leader then assumes charge of the situation. The goal of the code gold team is to use the least restrictive measures to safely work with the patients. However, if attempts to de-escalate the patient do not prove successful they will place the patient in restraints. In the event there is no provider at the bedside, the primary nurse can ask that the patient be placed in restraints but has the responsibility of obtaining a provider order within 1 hour. It is the primary RN and ~~providers~~ responsibility to document the behavior/justification and place the order. The code team only provides documentation of the code times and outcome.		'''Once the plan has been discussed with the team, the code gold team leader then assumes charge of the situation.''' * The goal of the code gold team is to use the least restrictive measures to safely work with the patients.
	** In the event the provider or primary RN does not want the patient placed in restraints, please note that the code team cannot stand-by while care is being provided as they all have their own patient care assignments to return to. It will then be the primary ~~teams~~ responsibility to manage the patients behavior. A code gold can be reactivated as needed.		*** However, if attempts to de-escalate the patient do not prove successful they will place the patient in restraints to maintain patient and staff safety while allowing time for medications to have an effect.
			*** In the event there is no provider at the bedside, the primary nurse can ask that the patient be placed in restraints but has the responsibility of obtaining a provider order within 1 hour. It is the primary RN's and provider's responsibility to document the behavior/justification and place the order. The code team only provides documentation of the code times and outcome.
			** In the event the provider or primary RN does not want the patient placed in restraints, please note that the '''code team cannot stand-by while care is being provided''' as they all have their own patient care assignments to return to. It will then be the primary team's responsibility to manage the patients behavior. '''A code gold can be reactivated as needed.'''


	** The team leader will direct his/her team and give specific assignments. You should not get involved in the code gold process unless you are requested by the team leader. For safety purposes the code team should not move forward until all 5 members of the team have arrived with exception of immediate intervention to prevent harm. This is less of a problem in the ED as most staff have completed the AVADE III/CPI training and can assist as directed by the team leader. The team members come from our various psychiatric units and may take 2-7 minutes to respond. There is only one code gold team each day so more than one code gold call at a time will delay response further.		** The team leader will direct his/her team and give specific assignments. You should not get involved in the code gold process unless you are requested by the team leader. For safety purposes the code team should not move forward until all 5 members of the team have arrived with exception of immediate intervention to prevent harm. This is less of a problem in the ED as most staff have completed the AVADE III/CPI training and can assist as directed by the team leader. The team members come from our various psychiatric units and may take 2-7 minutes to respond. There is only one code gold team each day so more than one code gold call at a time will delay response further.
	** Please do not ask that the patient be medicated prior to being restrained (not just held down). This is for the patient and staff safety. If the patient is restrained to the paramedic gurney, the code gold team leader will make the decision on how secure and safe he/she feels the situation is. The primary nurse will be responsible for medicating the patient.		** Please do not ask that the patient be medicated prior to being restrained (not just held down). This is for the patient and staff safety. If the patient is restrained to the paramedic gurney, the code gold team leader will make the decision on how secure and safe he/she feels the situation is. The primary nurse will be responsible for medicating the patient.
	** It is a regulatory requirement that a debriefing occur immediately after the code situation has concluded. The primary RN and provider should be available to participate in the post debriefing.		** It is a regulatory requirement that a debriefing occur immediately after the code situation has concluded. The primary RN and provider should be available to participate in the post debriefing.

	* If you are concerned that an agitated patient may become violent and feel you need support while determining capacity or hold criteria, you may call the Sheriffs at x64450 to briefly standby during your initial assessment (they are unable to stay for a prolonged time period). Always utilize de-escalation tactics such as active listening, a calm but firm voice, being down at eye level, providing personal space, offering choices, and providing food. At the same time, it is imperative you keep your distance and maintain situational awareness, preserving unimpeded access to the doorway for rapid escape. Recognize that the presence of law enforcement may escalate or de-escalate the situation and adjust accordingly. Be aware that the Sheriffs are not legally allowed to touch or physically restrain a patient unless a crime has occurred (eg, someone has already been assaulted). If the patient’s behavior escalates, please call a Code Gold and document/timestamp the rationale and restraint orders as soon as possible.		* If you are concerned that an agitated patient may become violent and feel you need support while determining capacity or hold criteria, you may call the Sheriffs at x64450 to briefly standby during your initial assessment (they are unable to stay for a prolonged time period). Always utilize de-escalation tactics such as active listening, a calm but firm voice, being down at eye level, providing personal space, offering choices, and providing food. At the same time, it is imperative you keep your distance and maintain situational awareness, preserving unimpeded access to the doorway for rapid escape. Recognize that the presence of law enforcement may escalate or de-escalate the situation and adjust accordingly. Be aware that the Sheriffs are not legally allowed to touch or physically restrain a patient unless a crime has occurred (eg, someone has already been assaulted). If the patient’s behavior escalates, please call a Code Gold and document/timestamp the rationale and restraint orders as soon as possible.



	==ED Policy #6 (OSA)==		==ED Policy #6 (OSA)==