| Recommended Readings, Tips & Pearls |
| *TS: – Tracer Methodology 101: Using Mock Tracers to Evaluate Care of Patients with Intellectual Disabilities, Part 1 (PDF/QV) The Source, December 2015, Vol 13, #12, Pg 4 AND Tracer Methodology 101: Using Mock Tracers to Evaluate Care of Patients with Intellectual Disabilities, Part 2 (PDF/QV)[REF: AOM, MD, RN, SC] The Source, January 2016, Vol 14, #1, Pg 4 JCs1510_B1 JCs1601_B1
This article was of potential interest because of the not insignificant frequency of dually diagnosed individuals (to include intellectual and developmental disability) in our psychiatric hospital populations. Unlike the regular offerings in the Tracer 101 series, this is presented in two parts and we elected to wait until both parts were available. The articles attempt to capture the results of a number of mock tracers focused on patients with intellectual disabilities (ID) conducted over the course of a year at an academic medical center in Chicago. Part 1 describes a number of concerns uncovered by the tracers. As the tracers were performed on acute inpatient units, perioperative units, the emergency department and pediatric and neuroscience intensive care units most of the difficulties identified are not particularly relevant to our facilities. The exceptions would be the universal issues of communication and inadequate information upon admission that are perhaps even more important for individuals with ID. A tool referenced in Part 2 is actually just a 6-item questionnaire used to guide the mock surveyors. However, this is probably the most useful aspect of the combined article’s 6 pages. Why, because it potentially reveals some key questions that TJC surveyors would be likely to ask and you should certainly ask your own staff if you serve individulas with ID. They include: |
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2 responses to “RTN1601_B1_Tracer: Patients with Intellectual Disabilities – Parts 1&2”
For staff and administrators of a state psychiatric hospital, it is easy to overlook the relevance of an article describing the experience of clinicians in a “Major Medical Setting”, such as the one featured in this month’s “Tracer Methodology” article.
If you are one of the state employees referenced above, one tip I would offer is to look past “the setting” and focus entirely on the needs of the patients being served and the adjustments made by the staff of the medical center to communicate with individuals whose care is complicated by an intellectual disability.
If you are successful at looking past “the setting”, I believe you can find relevance to your work with individuals with an intellectual disability in a state psychiatric hospital environment. The article describes special efforts during the functions of Pain assessment and Management, EOC, Specific patient needs, Information Management, Transitions of care, specialized equipment and discharge planning. I recommend that this list be broadened to include all assessments conducted by state hospital staff.
The first “Mock Tracer Tool” Question, sets the stage for all other questions throughout the assessment process; How does your hospital determine if a patient has an intellectual disability?
If you can specifically answer this question for your state psychiatric hospital, then the next question is ; How do we make adjustments for this special need during our assessment and care processes given this disability?
As we are acutely aware, many of the patients admitted to a state psychiatric hospital are disabled or have become disabled due to the effects of a prolonged and severe mental illness, but your hospital’s definition of an intellectual disability will likely focus on those patients who intellectually cannot communicate sufficiently to participate in their own recovery.
The staff must recognize this inability and work to shape the assessment and care processes to the patients unique needs.
The 6 tracer tool questions are a good beginning, but the needs of patients in a state psychiatric hospital are generally more intense and require additional tracer tool questions unique to your patient assessment and care processes and your setting.
This article is very timely given that over the last 6 months we have noted an increase in the admissions for intellectually disabled patients. As Medical Director in a state facility, I remain concerned about the care we provide for this patient population and is it adequate. This article certainly highlights some of my concerns including are we assessing for pain appropriately as well as a patient’s aggression or agitation. At this time our standard assessments occur with this population as well as consideration of a behavioral plan. Our facility will certainly begin to reassess our process.
Submitted 1/30/16 by:
Joyce R. Miller, MD, Medical Director,
Madden Mental Health Center, Hines, IL