Clinical Management

Clinical Management A. Each holding facility must have written procedures and documentation for clinical management of people who are involved in or have been involuntarily civilly committed and awaiting transportation. These procedures shall include, but not be limited to, the following: 1. Immediately upon arrival of the person to the holding facility, all mental health screening information (pursuant to civil commitment procedures) must be made available to the holding facility personnel. 2. Immediately upon arrival or within 24 hours, a medical screening should be conducted and documented by a RN or nurse practitioner that includes, at a minimum, the following components: (a) Vital signs (at a minimum: body temperature, pulse/heart rate, respiratory rate, and blood pressure); (b) Accu-Chek monitoring for people with diabetes; (c) Medical/drug history; (d) Allergy history; and (e) Psychiatric history (refer to Pre-affidavit Screening form). B. Clinical Management of the person being held must include: 1. Within 72 hours of admission, people should be assessed by a physician (preferably a psychiatrist) or a nurse practitioner. 2. Twenty-four (24) hour crisis/on-call coverage by a physician or psychiatric nurse practitioner. 3. Availability of ordered pharmacologic agents within 24 hours. 4. Timely administration of prescribed medication, in accordance with the scope of practice of the appropriate licensure board. 5. Access to medical services for pre-existing conditions that require ongoing medical attention (e.g., high blood pressure, diabetes, etc.). 6. Immediate availability of a limited supply of injectable psychotropic medications, and medications for urgent management of non-life-threatening medical conditions (e.g., insulin, albuterol inhalers, and medications used for withdrawal management). 7. Ongoing assessment and monitoring for people with mental illness or substance use considered by medical or psychiatric personnel to be at high risk. 8. Training/certification of employees in prevention/management of aggressive behavior program (refer to Chapter 12). 9. Procedures for maintenance of people’s records, including: (a) Documentation of information by professional personnel across disciplines; (b) Documentation of physician’s orders; and (c) Basic personal data and information that ensures rapid emergency contact, if needed.