Inpatient Program Protocol

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Program/Treatment Protocol

  Date

Activities/Programming 580.6(a)(4), 582.6(a)(4), Part 27.5, Part 21

• Varied groups (protocols); sufficient numbers based on census, Individualized; address cultural needs, Addressed in treatment plans, Active Treatment, Experienced/trained staff (cultural awareness), Evening/weekend activities

  Yes

  No

  N/A

Coordination of Care 580.6(a)(1), 582.6(a)(1)

• Family/Collaterals, Providers

  Yes

  No

  N/A

Discharge Planning Part 27.4(c ), 580.6(a)(4)

• Beginning at admission, Patient/family/collateral involvement, Discharge follow up, # of AMA discharges

  Yes

  No

  N/A

Records 580.8, 582.8, 527, NHL 9.07, Part 15, Part 17, Part 21, Part 27, OMH ECT guidelines

• Recidivism/multiple admissions *See record review, discharge record review

  Yes

  No

  N/A

Special Procedures Part 527.8

• acupuncture, ECT, hypnosis, biofeedback, restraint, seclusion

  Yes

  No

  N/A

Patient Education 580.6(a)(5), 582.6(c )

• Peer advocacy, School Education (under age 18), Barriers to learning identified

  Yes

  No

  N/A

Treatment Planning/Case Conferencing Part 27.3, 580.6(a)(2), 582.6(a)(2)

• documentation, patient/family/collateral involvement, address cultural needs

  Yes

  No

  N/A