Review of ECT Practice at Riverview Hospital - ECT Practice at Riverview Hospital

Written by Riverview Hospital Report

Drug Supply: Sufficient and appropriate drugs are readily available. Drugs and equipment required for resuscitation are also appropriately stored, labelled, and immediately available. Surveillance and replenishment of dated drugs is an ongoing commitment of Riverview Pharmacy.

Practice: The current practice in the provision of anesthesia for ECT at Riverview Hospital conforms to the "Guidelines to the Practice of Anesthesia, revised edition 2000" as recommended by the Canadian Anesthesiologists' Society. The safe and courteous conduct of anesthesia was apparent, as was the cooperative compassionate approach to patient care.

Recommendations: a) "Real time" monitoring of oxygen supply pressure should be provided. b) Auditory and visual alarms to notify personnel of failure of oxygen supply are also recommended. c) Consideration should be given to the use of "needle-less" supplies for the administration of drugs and/or intravenous fluids. There is no doubt that patients receiving therapy later in the day do benefit from intravenous fluid administration, and such fluids may be given utilizing one of the several "needle-less" products which are currently available. The principle advantage of using "needle-less" supplies continues to be the reduced risk of "needle-poke" injuries.

3. Care Plan and Documentation

Assessment: We reviewed the following documents and guidelines:
* ECT Consent Process (Flow sheet)
* Consent for ECT Treatment (Guidelines)
* Consent for Treatment, Involuntary Patient
* Consent for Treatment, Informal Patient and Outpatient
* ECT - Information for Patients and Families (1997)
* Preparing for ECT - Information for Inpatients (1997)
* Preparing for ECT - Information for Outpatients (1997)
* ECT Information For Students (1996)
* Pre-ECT Nursing Checklist
* ECT Ward Nursing Guidelines
* Request for Consultation (form)
* ECT Service Procedure Manual: Pre-ECT/Pre-Anaesthesia Consultations
* Pre-ECT Medical Checklist
* Medications Used In ECT - A Brief Compendium for Ward Nursing Staff
* ECT Service Procedure Manual: Duties of the Escort Nurse
* ECT Service Procedure Manual: Duties of the Waiting Room Nurse
* ECT Service Procedure Manual: Description of the ECT Treatment Process
* ECT Service Procedure Manual: Clinical Nursing Procedures in the ECT Room
* ECT Service Procedure Manual: Description of the ECT Treatment Process
* Medical Staff Policy & Procedure Manual: ECT (1997)
* ECT Service Procedure Manual: Anaesthesia Procedures in the ECT Treatment Room
* ECT Treatment Room Drug List (1996)
* Communication In the ECT Suite
* ECT Treatment Record
* ECT Nursing Record
* Methicillin Resistant Staphylococcus Aureus Guidelines (MRSA) (1997)
* Management of Patients Infected or Colonized with MRSA and other Multiple Drug-Resistant (MRO) Microorganisms
* ECT Service Procedure Manual: PARR Equipment
* ECT Service Procedure Manual: PAR Nurse Qualifications
* ECT Service Procedure Manual: Clinical Nursing Procedures in the PARR
* ECT Service Procedure Manual: Documentation In the PARR
* ECT Service Procedure Manual: Nurse to Patient Ratio in the PARR
* ECT Service Procedure Manual: Post Anaesthesia Recovery Room
* ECT Service Procedure Manual: Medical Emergency - Code Blue
* ECT Service Procedure Manual: Criteria For Discharging Patients from the PARR
* ECT Outcome Evaluation

Recommendations:
These guidelines are comprehensive and clear and only minor changes are recommended:
a) Aortic Stenosis is not listed in the "Medical Staff Policy and Procedure Manual (1997)" as a relative contraindication
b) The document "CLI-005 Description of the ECT Treatment Process" contains inaccurate information and is poorly written. It needs to be revised and the author and purpose of such a document identified.

4. Preparation and Aftercare

Assessment: Preparation of the patient begins as soon as a decision has been made that ECT is a recommended treatment choice for the patient. The attending physician discusses treatment options with the patient including the possibility of ECT. An "Information for Patients and Families" booklet on ECT is given to the patient and family members if possible, prior to being asked to sign consent for ECT. The patient and family members both have the opportunity to meet with the attending physician to ask questions about the recommended ECT. If the patient is capable of giving informed consent the attending physician will meet with the patient and review and explain the information on the back of the ECT form.