Opinion ID: 1301958
Heading Depth: 1
Heading Rank: 3

Heading: staff coordination

Text: One of the great problems at Huntington State Hospital is that when a treatment plan is drafted for a patient (which is all too seldom), it is often drafted during a meeting at which no one who has worked with the patient is present. Worse, there is often no one present with psychiatric training. One of the physicians at the hospital has no advanced training in psychiatry, nor do many of the attending nurses. Obviously when treatment plans are drafted by untrained people with no personal knowledge of the patients, they seldom meet the needs of the patients. Even when a good plan is drafted it is seldom implemented consistently or at all by the three different shifts of staff who work with the patient each day. An example of this problem is best shown in the response to M. R's. screaming. The psychiatric aide in charge of Ward 11 during the day shift thinks that petitioner R's. screaming is an attempt by the patient to communicate; therefore, the aide responds with positive reinforcement. However, the staff members on other shifts generally think that the screaming is symptomatic of a psychiatric problem and respond with control techniques. This failure of treatment at such a basic level is symptomatic of an overall dearth of professional administration of the health services at the hospital. Another critical problem with staff coordination is that no individual staff member is assigned the responsibility for follow-up work to assure compliance with the treatment plans. When certain therapy is recommended, there is never a listing of those responsible for conducting the therapy, when it will be conducted, and who is responsible for reviewing the patient's progress. When E. H. was moved from a ward to the pre-discharge unit, the staff of the pre-discharge unit drew up a treatment plan for her without reviewing either her old treatment plan or her other records at the hospital. As a result, her new treatment plan had no mention of the fact that she had alcohol problems. The irony of this omission concerning a woman who has virtually a lifelong chronic alcohol addiction is staggering and points out the sad problems encountered when there is no coordination and no detailed responsibility for treatment, follow-up, or supervision. In a psychiatric ward a patient interacts with many staff members during the course of each day. It is critical that all of the staff members be instructed concerning the patients' problems and needs in order that each staff member will know what is expected of him. In the case of L. S. a doctor diagnosed her as having an atypical psychosis. This evaluation was made without the benefit of an in-depth examination. Worse, this diagnosis is extremely rare, and few of the lesser trained staff would have any idea what it means either in terms of her actual problem or in terms of proper treatment. Unfortunately, her record is devoid of any explanation of the diagnosis, which leaves the staff in utter ignorance about a proper response. Lack of adequate documentation is the most easily observed shortcoming at the Huntington State Hospital. Documentation fulfills a critical function in psychiatric treatment. Clinical records are the basis for planning and continuity of patient care. They provide a means of communication among all the mental health professionals who are involved in the patient's program. These documents list continuing treatments and the observations about the patient's response to treatments as they are being applied. The records also serve as the basis for review of progress and as a basis for periodic evaluation of the individual patient care given by a facility. Finally, such records serve to assist in protecting the legal rights of both the therapist and the client. While this shortcoming is easily recognizable, its negative impact on the well-being of the patients can only be imagined.