Provide a consistent process of patient care that ensures the appropriateness, effectiveness, and safety of the patients medication use. Walk Independently 9. The clinical forensic experience is, of necessity, a part-time experience. Be able to relate clinical information (e.g., medical records, psychological testing, clinical interview) to a specific question in the legal context (e.g. Once trust is established, people tend to be more open to discussing their strengths and objectives. The effects of atomoxetine take longer to achieve. The Anxiety Disorders Clinic provides consultation and treatment on treatment-refractory cases that are often referred from the Department, Hospital, and community. 2016-04-27T00:08:20Z Knowledge of the techniques used in the evaluation of adults with treatment-resistant mood disorders (TRMDs), including evaluation of previous pharmacologic, somatic, and psychotherapeutic treatments. What follows are descriptions for each of the treatment goals: Microsoft Word - T019_ProgramGoalsObjectives_MAT.doc 3. Knowledge of the techniques and interview styles used in the evaluation of older adults with sensitivity to cognitive disorders what are common in this population. Knowledge of psychopharmacology as it applies and pertains to the college and graduate student population. View a general overview on medication treatments for ADHD and how the medications work. The resident will Conduct supportive psychotherapy for select patients who are currently going undergoing crises, going through transitions, or otherwise are appropriate for these services. 1 0 obj The following Goals and Objectives apply to all psychotherapeutic modalities. Reasonable timeline: 6 months of therapy. Organizations should set a goal of zero medication errors and ADEs, including those associated with modifying patient regimens. Agency for Healthcare Research and Quality, Rockville, MD. <> }8yek{EN'p\>[/4+cje*,667 end4I0 l|FU1eDz9Lh'-nW[5|=gqBB/d(t[w!kR0[Hl~#5T+yw/Va_G>_TkY&}^/nanQq X|73G@(;QI4G/mv0jF;Rh?`)So\K=w=y3rO5 (p)F'jO[=nzoWl^. Respect for, and communication with referring physicians, therapists, and caregivers to optimize treatment. Client experiencing medication side effects . Geneva: World Health Organization; 2009. By definition, all medication errors are preventable. Currently, two classes of FDA-approved medications are used for ADHD treatment: stimulant and non-stimulant. become familiar with means of preventing life-threatening complications of clozapine. Sustain a Tripod Grasp Control 4. It should cover common side effects (so patients aren't surprised if they occur) and what patients should do if they experience common or uncommon side effects. competency to stand trial, suitability for conditional release following a successful insanity plea, psychological damages in civil cases, etc. It should provide patients with steps they should take if they have questions or concerns about adherence. The General Adult Psychiatry Clinics provide diagnostic evaluation and treatment for a range of psychiatric disorders in adults, including bipolar and unipolar affective disorders, anxiety disorders, adjustment disorders, attentional disorders, personality disorders, and some psychotic disorders. It is a potent selective norepinephrine reuptake inhibitor. ), Suicidal or homicidal ideationsSubstance use or dependence, Extreme psychosocial stressors or recent traumatic events, Atypical presentation if presentation as brand-new symptoms this is not ADHD; even if not diagnosed as a child the symptoms must concur, Poor or no treatment effect after repeated medication adjustments. Some people report small changes in hyperactivity and impulse control within two weeks, but it may take 4 to 8 weeks for the drug to achieve maximum effectiveness. Sep 2022 - Present7 months. Education of patients about anxiety disorders. The time that nurses spend in clarifications had greatly reduced and this allows nurses to focus more on patients care. Exercise is an important part of a healthy lifestyle, and should be recommended for both health and possible ADHD benefits. Provide a job aid for staff for creating a medication list with a patient or family member. The idea remains that the dispersal of stable patients to MNAs in regards to medication administration allocates more time for RNs/LPNs to prioritize care for critical patients. For example: Initech's goal was to increase annual profits. endobj Willingness to be flexible so as to be able to accommodate the behaviors that result from the pressures of student life. Be familiar with the various diagnostic conditions seen during childhood and adolescence including ADHD, Conduct Disorder, Anxiety Disorders, Substance Abuse Disorders, and Learning Disabilities, Understand the difference in symptomatology between children, adolescent, and adults, Understand the occurrence of commonalities in children and adolescents, Develop competency and appropriately prescribe and manage stimulant medication for ADHD including Ritalin, Dexedrine, and Adderal, Develop competency and appropriately prescribe and manage non-stimulant medication for ADHD including Wellbutrin, Clonidine, and Strattera, Develop competency and appropriately prescribe and manage SSRI medications for depression and anxiety, Be aware of the various structured diagnostic tests (CBCL, Conners, CDI, etc. A PCP can serve as another source of education, further stressing the importance of adherence and answering questions patients may have about their new regimen now that they have been on it for a few days. This way it makes it difficult for the CM to sign off all the medications at once for the residents when setting them up. Medication Management and Occupational Therapy. Non-measurable goal Patient will be less isolated. Identify the specific sequence of activity in which a medication habit can realistically be embedded. As a P1 student in SDSUs pharmacy program one of the activities required to prepare us for real world pharmacy practice would be to take part in a medication adherence simulation. A stable patient is defined by the New Hampshire Board of Nursing as one whose overall health status, as assessed by a licensed nurse, is at the expected baseline. Residents will demonstrate knowledge of evidence-based treatment approaches to addictive behaviors. 2016-04-26T17:08:21-07:00 A recognized best practice following discharge is an appointment with primary care practitioners (PCPs), preferably within one week of discharge. The clinics collaborate with primary care providers in the evaluation and treatment of medical problems which may intersect with psychiatric presentations, such as sleep disorders, some cortical and subcortical dementias which are comorbid with affective disorders, and the common renal, thyroid, hematologic and hepatic consequences of medications commonly used in psychiatric practice. Several tips and resources for the patients are summarized in the patient handout, Managing Adult ADHD. Rockville, MD 20857 5600 Fishers Lane It is devised to use as an indicator of a person's current condition as well as to define how the course of treatment will go further. endobj And yet thousands of deaths every year are attributable to adverse drug events (ADEs). 1 Healthy People 2030 focuses on the prevention, screening, assessment, and treatment of mental disorders and behavioral conditions. Techniques used in the evaluation of adults with anxiety disorders including evaluation of previous pharmacologic, somatic, and psychotherapeutic treatments. 3. At the end of this rotation, residents will understand and display competence in the following: PGY-3 residents spend 6 months in this clinic. No medication has been demonstrated to be effective in alleviating amphetamine withdrawal, but some medications may be useful with some symptoms. Six months after the introduction of medication aides, error rates were as follows: RN (2.75%), LPN (7.25%) and medication aides (6.06%) with a mean error rate of 6.6% Randolph & Scott-Calwiezell (2010) as cited in Budden (2011). The CCC provides services for patients with chronic severe mental illnesses. Knowledge of the types and indications for various neuropsychological tests and their interpretation. Residents will have the opportunity to work with patients who are dying and to develop skills dealing with end of life issues. It is designed to ensure Registered Nurses exercises professional judgment and should provide support when making clinical decision making. Referrals are received from all Medical Center specialties and from local as well as regional geographic areas. willingness to seek supervision for psychotherapeutic and pharmacologic assessments and interventions. Knowledge of side effects of the various treatments, and available treatment responses to them. You and your mental health provider will work together to define your long-term objectives from treatment. Respect for the patient's and the family's stress during evaluation and treatment of psychiatric disorders in older individuals for whom this may be the first contact with psychiatry. Residents will gain experience in liaising with community based (IBD support groups) and web-based resources. Learn to identify and promote adaptive coping abilities in patients and their families. These tools will also help to identify patient behaviors that may be putting patients at risk for an adverse drug event, such as overdosing, underdosing, or missing medications, or other important contextual factors limiting adherence. Ability to complete in-depth assessments to determine the diagnosis of Treatment Refractory Mood Disorders (TRMDs). Interestingly, the utilization of computerized order entry does not prevent the prescriber from ordering an incorrect medication dose or the wrong drug (Lapane, Waring, Dube, & Schneider, 2011). Establish a clear treatment framework (e.g., a treatment contract) with explicit agreements about the following: Goals of treatment sessions (e.g., symptom reduction, personal growth, improvement in functioning) When, where, and with what frequency sessions will be held A plan for crises AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund. 1. learn to assess the psychosocial readiness for a major medical procedure, a skill that translates to areas such as bariatric surgery, bone marrow transplant, and HIV care. case management service plans bizfluent, s m a r t behavior change outcome objectives, quick guide to Reporting medication errors is beneficial to improve the learning process for nurses. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Step 4 - Introduce Medication Management Materials to patients. Techniques used in the evaluation and treatment of adults comorbid presentations of anxiety disorders and other major psychiatric disorders (mood, alcohol/substance abuse, and dependence, etc.). gain an increased knowledge of the psychopharmacology considerations in a medically ill population and learn to work with the neuropsychiatric side effects of cancer-related treatments. Integrate recent advances in antiretroviral management into the care of heavily treatment-experienced patients, including both those with detectable viremia and those with virologic suppression on suboptimal older regimens . Respect for the patient's and the family's stress during the evaluation and treatment of cognitive disorders in older and middle-aged individuals. There is a documented withdrawal syndrome for stimulant medications. I have noticed some errors that needs to back up all the time. Ability to complete in-depth assessments to determine the correct diagnosis while attending to possible co-morbid medical and neuropsychiatric diagnoses. Internet Citation: Medication Management Strategy: Intervention. Referrals are received from all Medical Center Oncology Services (solid organ and hematological malignancies) and from local as well as regional geographic areas. Comorbid conditions such as mood and anxiety disorders are also highly treatable. If the medications themselves could be barcoded and scanned in before popping the medication in the medication cup, this would help the CM double check the five rights as well. Client lacks understanding of disease process . Familiarity with the literature related to their effectiveness, including newly emerging evidence. The following Goals and Objectives apply to all psychotherapeutic modalities. show concern and compassion with being either patronizing or overly-involved. Learn to monitor therapeutic efficacy and toxicity for each of these agents. Identify treatment goals and target behaviors Select interventions for achieving goals Choose measures to monitor outcomes of goal setting Follow up and modify treatment plans as necessary Treatment Planning At a minimum the treatment plan addresses the identified substance use disorder(s), as well as issues related to treatment progress, Step 3 - Train team members and initiate implementation. GENERAL OBJECTIVES Regardless of the healthcare setting or demographic of patients, safe outcomes are the purpose of providing patient-centered care. During assessment and diagnosis process, consider referral to a psychiatrist or mental/behavioral health professionals in the following several presentations and co-conditions: During treatment and monitoring, consider referral to a psychiatrist in the following situations: Most adult patients with ADHD can benefit from education about ADHD, skill building trainings and adjuvant psychotherapy. Treatments fall into four categories, based on their potential outcomes: Preventive. Learn to identify the resident's own vulnerabilities and sensitivities in this regard so that he/she cannot be blind-sided. The Mental Health and Mental Disorders objectives also aim to . Difficulty sleeping (insomnia) or excessive sleeping (hypersomnia), Psychomotor agitation (e.g., jitteriness, nervousness, moving quickly, edginess, etc.) serve in the role as the primary psychiatrist, with attending backup, for 40 patients with chronic severe mental illness. This multidisciplinary team meets weekly in case-based discussions and didactic sessions. Knowledge of complete and detailed neurological and psychiatric assessments needed for the evaluation of adults with cognitive disorders. supervise and educate medical students about psychiatric illnesses, interviewing techniques and presentation skills. Copyright 2023 IPL.org All rights reserved. Objectives help your team understand what needs to be done in order to achieve the intended outcome (goal). learn to evaluate psychiatric symptomatology in cancer patients and will become adept at distinguishing between symptoms arising directly from cancer or as the result of psychosocial adjustment to a devastating illness. Management Approach and Treatment Options. Checklist for staff to provide a quick reference for the steps to creating a medication list with a patient or family member. This worksheet (ARIES Master Data Collection Form) can be used to remind Medical Case Managers of the . Some cravings (not usually severe in this initial phase). Research conducted by Randolph and Scott-Cawiezell revealed trends in medication errors prior to and following the integration of MNAs. { Ql{Ont~UTgc/B/}rp6O^c:v+Fh, Microsoft Word - T019_ProgramGoalsObjectives_MAT.doc. Medication management is a strategy for engaging with patients and caregivers to create a complete and accurate medication list using the brown bag method. An intervention for preventing the medication error from happing again is implementing a better system in which the medications are administered. 9 SMART Goal Examples for Occupational Therapy 1. gain an increased knowledge of the psychopharmacology considerations in a medically ill population and learn to work with the neuropsychiatric side effects of transplant-related medications. Symptoms may include: The initial phase may last one to two days and then is followed by a longer period of several days to weeks of dysphoria (unpleasant or negative mood states). Residents will become aware of the range of services for patients with addictive behaviors including inpatient and outpatient substance use programs, self-help groups, and other available resources. Understand what it is like to have a severe mental illness, what are the barriers, internal and external, to recovery, and how psychiatrists and institutions can be of assistance. application/pdf Open and Close Containers Independently 6. The primary goal of treatment is to minimize the impact of ADHD symptoms on patient function while maximizing the patients ability to compensate or cope with any remaining difficulties. 400 0 obj <>/Filter/FlateDecode/ID[<38AE6961186DAC41A255D329ADBB4926>]/Index[388 29]/Info 387 0 R/Length 73/Prev 426904/Root 389 0 R/Size 417/Type/XRef/W[1 2 1]>>stream PGY-3 residents spend twelve months in the General Clinics. A Journal of Hospital Medicine study showed that "patients lacking timely PCP followup were 10 times more likely to be readmitted for the same condition within 30 days of hospital discharge and nearly seven times as likely to be readmitted for the same condition or receive other care.". Feel a sense of accomplishment. Trials of off medications and medication holidays can be used to assess the patient's functioning without pharmacotherapy. Patient will complete a medication evaluation with their medical provider. Methylphenidate and amphetamine are the two most commonly used stimulant medications for treatment of ADHD in adults (FDA-Approved Stimulant Medications for Adult ADHD). Verbalize understanding need for a process of forgiveness of others and self to reduce anger. Decrease Anterior Knee Pain 2. Identify the preceding activity, specific location, and support needed for taking medication. Knowledge regarding the various imaging and laboratory tests that are needed to assess cognitive disorders and their stages. Multivitamin supplements containing B group vitamins and vitamin C are recommended. Here are three worthwhile medication management goals to set for your organization. endstream endobj 389 0 obj <> endobj 390 0 obj <> endobj 391 0 obj <>stream An official website of the Department of Health and Human Services, Latest available findings on quality of and access to health care. Learn to generate short and long term treatment plans for patients, how to communicate them to patients and families, and modify them based on patient feedback. Word They have the ability and knowledge to implement programs as part of their daily practice to ensure that patients are adherent to their medications. About half of all people in the United States will be diagnosed with a mental disorder at some point in their lifetime. Patient education can go a long way toward overcoming these and other obstacles to adherence. Not all symptoms can be resolved with treatment; it is important to manage expectations of treatment and to promote a sense of responsibility and personal agency in patients. Pharmacotherapy - Effective 2017 . By taking extra caution to administer medications correctly, this honorable obligation will always be within, As a student, one of my competency to achieved to become a professional nurse is medication administration. Pediatric - Effective 2016. In addition, to the extent possible, the resident is encouraged to witness medicolegal testimony at deposition and/or trial. Job aid that can be used to help clinicians discuss the core challenges to filling and adhering to prescribed medications with patients and family members. Department of Psychiatry and Behavioral Neuroscience, the ability to complete a thorough general psychiatric diagnostic assessment, the ability to formulate a case, integrating biological, psychological, and social issues, the ability to generate and carry out a plan of care, including pharmacological, psychological and social interventions, the ability to identify issues and patterns better approached by psychotherapy than by medication. h But they also suggested that if a patient is presented with a condition in which they are competent to prescribe, then non-medical prescribers should be confident and competent to treat patient. The goal of metacognitive therapy in ADHD is to improve organization skills, planning, time management, and resolve thinking distortions that lead to negative moods and the perception of limited options. At the end of this rotation, residents will display the following: PGY-3 residents spend 12 months in child and adolescent psychiatry clinics. Education must speak to the importance of following a regimen and the risks of failing to do so. Sample process that can be used as an example when developing a medication management process. 3. Multiple Sclerosis brain involvement) or as the result of psychosocial adjustment to a devastating illness. Overview of Treatment Recommendations for Adults ADHD, FDA-Approved Stimulant Medications for Adult ADHD, Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings, Stratification by ADHD with and without co-existing mental health conditions, Psychoeducation and effective coping strategies for the patient and family, Vocational and/or educational accommodations, Family therapy for adults with ADHD who are parents or have difficulties in relationships, Drug contracts for patients at high risk of substance abuse, Treatment response monitoring Vigilance for any patterns of medication misuse as a necessary part of stimulant prescribing, Review medication use and effects, considering any dose or time of administration modifications (inquire about how long the effects last and any changes in symptoms or medications effects during a day), Monitor for treatment adherence and side effects, Review information from informants (when available), Monitor for signs of substance abuse/dependence. Organizations should also set a goal to follow up directly with high-risk patients, such as those with chronic conditions (e.g., heart disease, diabetes, epilepsy) and elderly patients taking many different medications. Provide a holding environment, Recognize and specifically describe affects, Tolerate direct expressions of hostility, affection, sexuality and other powerful emotions, Identify problems in collaborating with the treatment/therapist, Recognize obstacles to change and an understanding of possible ways to address them, Maintain focus in treatment when appropriate, Assess readiness for and manage termination from treatment, Assess the patient's readiness for specific interventions, Assess the patient's response to specific interventions, Identify aspects of an ongoing case in terms of theories of drive and defense, internalized object relationships, and consideration of the patient's self-experience, Link present to past as demonstrated by understanding the patient's present pattern of thought, feeling, action and relationship in terms of his or her past personal experience, Identify and elicit automatic thoughts and cognitive errors in thinking, and develop and implement a treatment plan employing CBT strategies and techniques, Establish and maintain a professional relationship, Understand and protect the patient from unnecessary intrusions into privacy and confidentiality. the types of psychotherapy, and their indications, which are effective in managing the problems seen in a general psychiatry clinic. A complete and accurate medication list is the foundation for addressing medication reconciliation and medication management issues. As for private hospital we do practice cost saving and by recommending this system my organization would be able to achieve cost saving as well as incentives and improved efficiency in delivering high quality and safe care for our patients. A bar-code electronic medical administration record (eMAR) technology associates several technologies into the medication administration process to provide the correct medication, dose, time, route, and patient. <> Organizations should then implement changes and monitor and measure whether these changes are having the effects desired that will help prevent such a medication error from occurring again. ). Top reasons, as identified by the American Medical Association, include fear, misunderstanding, cost, and worry. Advantages and risks of typical and atypical antipsychotic medications, in particular: learn to identify and treat tardive dyskinesia in its earliest stages. Setting goals in a treatment plan helps patients: Feel motivated. Ability to complete psychopharmacologic assessments of TRMD patients and to follow-up these patients. Ability to understand and use neuropsychological data, various imaging, and laboratory data to arrive at the correct diagnosis and treatment plan for each individual. It is available in two sizes for printinga full-page format or a half-page brochure: Poster, flyer, or handout that explains the goal of medication management and the patient and family role in the medication management process. Boost their self-esteem. - Moderate caloric deficits - Weight loss 1 to 2 lb/week The initial target goal of weight loss therapy is to decrease body weight by 10 percent. Medication Management Strategy: Intervention, https://www.ahrq.gov/patient-safety/reports/engage/interventions/medmanage.html, AHRQ Publishing and Communications Guidelines, Evidence-based Practice Center (EPC) Reports, Healthcare Cost and Utilization Project (HCUP), AHRQ Quality Indicator Tools for Data Analytics, United States Health Information Knowledgebase (USHIK), AHRQ Informed Consent & Authorization Toolkit for Minimal Risk Research, Grant Application, Review & Award Process, Study Sections for Scientific Peer Review, Getting Recognition for Your AHRQ-Funded Study, AHRQ Research Summit on Diagnostic Safety, AHRQ Research Summit on Learning Health Systems, Guide to Patient and Family Engagement in Hospital Quality and Safety, Guide to Improving Patient Safety in Primary Care Settings, About AHRQ's Quality & Patient Safety Work, Sample Process for Medication Management Strategy, Common Barriers to Medication Adherence full, Common Barriers to Medication Adherence pocket, Procedure: Engaging Your Patient To Create a Medication List, Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation, Consumers Page Treatments & Medications, U.S. Department of Health & Human Services. The factors of workload, ineffective communication, and distraction all contribute to medication errors (Sears et al., 2013). Knowledge of interactions between drugs used in mood disorders treatment, as well as interactions with drugs used for common medical disorders. Simple list that is used by practice staff who engage with the patient and/or family member during preparation and is then used for medication reconciliation. PSYCHOTHERAPY LEARNING OBJECTIVES FOR SPECIFIC PSYCHOTHERAPEUTIC MODALITIES, COMBINED PSYCHOPHARMACOLOGY AND PSYCHOTHERAPY. The overall goal of the program is to develop psychiatrists competent to practice independently in each of the competency areas detailed below. educate and provide therapeutic interventions and care coordination to best meet client treatment . PATIENT CARE. Ability to educate patients and families regarding TRMDs. All the terrific treatment your organization provides to a patient may be for naught if that patient fails to adhere to the medication regimen determined by your clinicians. ), Be able to explicate the differences in purpose and organization between a clinical and a medicolegal evaluation, including the different ethical responsibilities entailed, neurological illness and co-morbid psychiatric disorders, psychiatric disorders presenting with neurological symptoms, neurological disorders presenting with psychiatric symptoms, neuroanatomy and neurophysiology as they pertain to patient presentations, common neurologic disorders and their management, presentations of neuropsychiatric syndromes, the intersection of neurology and psychiatry, an understanding of the consultation process, and responsivity to consultation questions and requests, an understanding of the resources available to patients at the interface of neurology and psychiatry.