General Adult Psychiatry

GENERAL ADULT PSYCHIATRY, OUT-PATIENT SERVICE

The OPD runs on all working days except the Institute-specified public holidays
The OPD Registration timings are, all days except Saturday 09.00 hours; Saturday 08.00-10.30 hours.
All new cases are seen in the WIC (Rooms 205-206), and all old cases without a designated clinician being available in the Follow-up Clinic (Rooms 207-208)

The following Specialty Clinics also operate, by appointment, on designated days and run by the SR under supervision of particular Faculty members:

Lithium Clinic (Tuesday)
MPC (Wednesday)
Disability Clinic (Saturday)

Generally the SR posted in Room No 205 in the OPD is designated as the coordinator of the OPD services; he/she also sees the WIC

All SRs are expected to:

Participate in all academic activities of the Department
Guide and help JRs in their academic activities
Carry out research projects under the faculty supervision

Duties of SRs in Walk-In-Clinic (Rooms 205 & 206)

Patient Management:

To reach OPD by 8.00 AM, except on the days with academic teaching, when they must reach OPD by 9.15 AM
To assess the Walk-In patients thoroughly, and begin the treatment and give date for detailed workup of the patient at the earliest
To consult a Faculty if there is any confusion regarding patient management
To inform the respective Faculty about cases with high risk, medico-legal, certificate for illness/leave/chronic disease, or any other significant issue
To stay in constant touch with JRs for all their common cases, especially who are critically sick or having any medico legal issues
To regularly supervise the JRs for their psychotherapy cases/sessions

Administrative Work:

SR Room 205

To liaise between the OPD staff and Faculty I/C OPD; he must work to resolve whenever there is any confusion regarding administrative work
To ensure that the OPD services are running in good order
To ensure the proper up-keep of OPD and must coordinate for all OPD services/work i.e. record keeping, purchase or indent
To organize an administrative meeting periodically in consultation with the OPD Faculty I/C
To manage safe-keeping of MLC case files /Cupboard keys and updating of MLC Register (including issue/receipt of MLC files). MLC files are to be handled by the 205 SR, exclusively and anyone who needs these files is expected to return it preferably in person to him/her. The safe custody of the MLC files is to be emphasized during the handover-takeover of duties of SRs
To ensure the entry of statistical data in the SPSS on a regular basis

SR Rooms 205 & 206

To allot cases for detailed assessment to JRs the cases before 8:15 am (by 9:30 am on the academic days).
To ensure that all JRs must reach OPD on time daily
To ensure that all JRs do their detailed work-up of cases within the allotted time (before 12 noon)
To ensure regularly that JRs follow their common cases and put the proper notes in their files
To ensure that the record-meetings are held regularly and the JRs are following the instructions, especially the management part (investigation, treatment etc.)

Duties of SRs Follow up Clinic (Rooms 207 & 208)

Patient management

To run the follow up clinic for all old cases for maintaining continuity of care
To inform the respective Faculty members about the cases who are high risk/MLC/require certificate for diagnosis/leave/chronic disease/other important issues
To closely supervise the JRs for the management of all patients
To assess follow up cases who have come without an appointment and the treating doctor is not available

Administrative role

To reach the OPD by 8 AM (except on academic days, by 9.15 AM)
To ensure that all JRs must reach on time everyday
To ensure that JRs are following their patients regularly and putting proper notes in their file
To inform the respective Consultants in charge regarding the status of the patients and JRs performance
The responsibility of holding record meetings and supervising the JRs, as mentioned already
Get in touch with Faculty I/C OPD for guidance or in case of any difficulty

Admission Register

To maintain admission Register for those patients who need admission
To maintain admission lists for routine and priority admissions
To liaise with ward SR and C-L SR regarding the availability of beds
To inform the patients for admission, according to the waiting list
To maintain SPSS and word file of updated waiting list, to be sent to Faculty I/C OPD

Duties of SR Posted in Special Clinics
All the SRs posted in respective specialty are expected to maintain their Register, and regularly inform the respective Faculty I/C about the status of patients, patient data, and JRs‖ performance.

General Instructions:

OPD start at 8.00 AM (except the Departmental academic days, at 9.15 AM)
F/U OPDs on Tuesday, Wednesday and Friday. F/U OPD for CAP on Tuesday and Thursday afternoons
To maintain a log of activities of MPC, Lithium Clinic, DC and Psychotherapy
Allot cases for workup for disability and psychotherapy by 8.30AM on routine days (9.15AM on academic activity days)
Maintain a log of patients undergoing psychotherapy
Supervise the work of JRs posted in psychotherapy

Psychotherapy

Runs in all working days
Allot psychotherapy cases to JRs
Do psychotherapy if SR doing it him/herself
To see follow up cases on regular basis
Case discussion with JRs.
Ensure psychotherapy entries in SPSS and discuss it with Faculty on monthly basis MPC (Wednesday)
To see MPC walk in cases on a daily basis
To give dates for detailed assessment
Discuss MPC cases with JRs and advise management
To give non pharmacological treatment to MPC cases
Supervise JRs
Maintain MPC Register and SPSS data
Receive applications from concerned Faculty I/C
Allot dates to patients for disability assessment
Supervise assessment
Ensure precise entries in all the respective file
Dispatch filled assessment report to CRD

Lithium clinic

It runs on Tuesdays
To see follow up cases on patients on Lithium
Receive lithium level reports
Maintain Lithium Clinic numbers (LiC No) in a file
Ensure lithium level supervision of the patients
Maintain Lithium Clinic Register

Service Responsibilities of Junior Residents (JRs) in OPD

JRs posted in the OPD are expected to reach OPD and report to SR Room 205 by 9.15 AM on days with morning academics (other days by 8 AM)
They do detailed work-up of the cases given appointment for that. It includes a detailed history, physical and mental examination to establish the diagnosis and then to chalk out a comprehensive treatment plan
Each such case assessment must take 1 hour (never more than 1.5 hours). Each day they will have to do detailed work up of at least two patients; the SR of the respective clinic will decide the number of cases allotted to each JR
Each assessed case is to be discussed with a Faculty/SR for finalizing the diagnoses and plan of management, which has to be recorded in the case notes
They are responsible for providing the longitudinal care to the patients they have worked up
To minimize the number of drop-outs every JR must keep a diary for the appointments of their patients. This diary should also include patient’s psychiatry number and phone number so that in case of missed appointments they can be contacted
They carry out the active treatment of the patients under the supervision of the Consultants and /or SRs. They are also responsible for the adequate maintenance of the case files. They must record each follow up carefully
In follow up notes must mention the following details: present status of the patient, treatment adherence, any side effects, any important psycho-social event, and further investigation and treatment advised
In addition, JRs will carry out other duties that the SR I/C may allocate for better patient care and administration of the OPD. They make timely entries in Psychotherapy-Register to the special clinic SR for their psychotherapy cases
JRs posted in psychotherapy have to attend referral of patient for appropriate psychotherapeutic interventions like JPMR, BT, CBTetc on a daily basis. On Wednesday JRs have to do MPC work up and discuss it with concerned consultants or SRs. In addition, to carry out various therapies like Couple therapy, Master and Johnson etc. Carry out disability assessment and discuss it with the consultant in charge on Saturdays. JRs have to maintain a log of patients for disability assessment

OPD Record Maintenance

Walk-In Proforma and face-sheets of each day are maintained by the PSW for the immediate past three months and by the Record Room for the earlier period
Separate files are made for appointment/detailed assessment cases
Each case file must contain a psychiatry number, socio-demographic sheet and a Walk-In Proforma
Faculty’s remarks and follow-up notes are entered in the same file
All files are kept in the record room of the Psychiatry OPD except for actual/potential medico-legal cases, which are kept under lock and key with the SR Room 205
All records are confidential. No patient, patient’s relative or any other people except the staff members of the Department of Psychiatry, who have a legitimate access, are allowed to handle the case files
Case record meeting is held on every Monday afternoon in rotation with the Consultants and SRs to scrutinize the out-patient records regarding proper maintenance of these files, as well as to finalize the diagnosis and guidelines about the management difficulties. The Residents, respective Consultants, and the OPD PSW attend these meetings
Before removal of OPD case files from the record room for any purpose, by the staff of the Department, entry of details of file and name of the person responsible/taking the file should be duly entered in the Register kept with OPD Clerk
All JRs and SRs should make sure that no file is left unattended at any place, at any time

Role of PSW, OPD

Clinical Work Assignments

To fill the socio-demographic profile sheet of the Walk-In Proforma of all the new patients attending in respective areas
To assess the needy patients for poor free status and facilitate the same if there is a need
To enter the data of Walk-In Proforma into the SPSS on day to day basis
To enter the work-up data into the SPSS after the record meetings
To organize and participate in group educational meetings for the patients in OPD
To carry out psychosocial work up as per the format of the patient assigned to them by various faculty members
To arrange and do home visits, meeting with employers, visiting workplace, rehabilitation services, legal services etc., for the patients assigned to them by various faculty members
To attend various camps, attend courts and educational programs organized by the Department
Liaise closely with SRs posted in the respective areas for assistance and completion of work allotted to them
Liaison with hospital authorities to facilitate poor free status, supply of free medications, liaison with MSWs of other Departments for treatment of patients etc

Academic

Attend the Departmental Academics – CC (one of the two PSW in OPD by turn); Seminar (Whole Departmental and specialty section). Can actively contribute for their part of assessment and intervention
May be assigned teaching responsibilities for various educational courses run in the institute like physiotherapy, speech and audiology
To participate in the research projects of various faculty members
To take initiative in conducting research under the guidance of faculty members

Administrative

May be assigned clinical and administrative tasks as per the need of the Department
To attend various Departmental administrative meeting
To organize and procuring medicines for community camps

Role of Vocational Guidance Instructor
Vocational Guidance Instructor are one of the important members of the clinical treating team and should be actively involved in psychological assessments, counseling and vocational guidance of the patients

Clinical Work Assignments

To do assessments of needs, interests, aptitude and vocational abilities of patients with mental illness
To do psychometric assessments (e.g., SLD, intelligence assessment etc.,) of patients of all ages referred to them in a structured format
To do structured psychological therapies (like psycho-behavioral interventions for subjects with intellectual disability, anger management, family counseling etc.,) of cases referred to them by the faculty
To guide patients and family members regarding disability benefits, vocational placements etc
Follow-up evaluation, maintaining records of the patients and inform the outcome to the concerned faculty
Education and counseling of the parents/ caregivers of the patients
To organize and participate in group educational meetings (ID group, Other Disability group etc.) for the patients in the respective areas
To enter the work done in the SPSS as per the policy
Contribute in other works related to patient care and in accordance with Departmental needs
Attend the Departmental Academics – CC; seminar (whole Departmental and specialty section). Can actively contribute for their part of assessment and intervention
Training of Residents and trainees about psychological tests and interventions
May be assigned teaching responsibilities for various educational courses run in the
To participate in the research projects of various faculty members
To take initiative in conducting research under the guidance of faculty members

Administrative

May be assigned clinical and administrative tasks as per the needs of the Department or the Institute
To attend various departmental administrative meetings
To assist in purchase of various psychological tests/instruments related to vocational and other psychological assessments

Role of Clinical Psychologist
Psychologists are one of the important members of the clinical treating team and should be actively involved in psychological assessments and interventions

Clinical Work Assignments

To do psychometric assessments of patients of all ages referred to them in a structured format
To do structured psychological therapies (like anger management counseling, family counseling, non dynamic and dynamic psychotherapies, behavioral therapies etc.) of cases referred to them by the Faculty/Residents
Follow-up evaluation, maintaining records of the patients and inform the outcome to the concerned Faculty
To organize and participate in group educational meetings for the patients in the respective areas
To enter the work done in the SPSS as per the policy
Contribute in other works related to patient care and in accordance with departmental needs
May be assigned teaching responsibilities for various educational courses run in the Institute, like in physiotherapy, speech and audiology etc
To participate in the research projects of various faculty members
To take initiative in conducting research under the guidance of faculty members

Administrative

May be assigned clinical and administrative tasks as per the needs of the Department or the Institute
To attend various Departmental administrative meetings
To assist in printing, purchase and maintenance of various psychological tests

Role of Play Therapist

Clinical:

The play therapist shall carry out psychological assessments and generate a psychological formulation for a child/ adolescent when specifically referred for the same by a consultant. In all such cases, the play therapist shall be part of the treating team unless specified otherwise
He/she will undertake specific therapeutic interventions under supervision (play therapy, behavior therapy, skill building, SLD remediation, occupational therapy, attachment work, supportive therapy, etc.)
Complete documentation of assessments and interventions by him/ her is mandatory
They will maintain a separate register for all such cases in which they are carrying out therapeutic interventions under supervision of a consultant
He/she will use play to prepare child for treatment like medicines, behavior therapies and to distract them during a procedure
He/she will plan and carry out therapy sessions using art and craft activities, toys (such as puppets, cars and dolls) and creative arts (including drawing, clay, sand movement, music and therapeutic story telling)
He/she will develop symbolic communication with children, which involves making a connection between the signs, symbols and actions the child creates through play and how these relate to their experiences (even using technique of psychodrama etc)
He/she will create an in-depth therapeutic relationship, which promotes positive change in the child by helping them to help themselves
He/she will help them reach their developmental goals
To help them regain their skills which they have lost due to illness and also help in learning new skills
To observe child during play and share their findings with the consultant I/C and the treating team
He/she will be responsible for maintenance and upkeep of the play room in their area (Ward/ OPD) in liaison with the respective SR
He/she will carry out a psycho-social work-up when indicated (as directed by a Consultant)
Liaise closely with SRs posted in the respective areas for assistance and completion ofwork allotted to them

Attend the Departmental Academics – CC (Whole Departmental and specialty section); Seminar (Whole Departmental and specialty section), psychotherapy forum (Specialty)and research forum. They are expected to contribute actively for their part of assessment and intervention
May be assigned teaching responsibilities for various educational courses run in the institute like physiotherapy, speech and audiology

Research

To participate in the research projects of various faculty members
To take initiative in conducting research under the guidance of faculty members

Administrative

May be assigned clinical and administrative tasks as per the need of the Department
To attend various Departmental administrative meeting
Contribute in other works related to patient care and in accordance with Departmental needs

GENERAL ADULT (AND GERIATRIC) PSYCHIATRY, IN-PATIENT SERVICE

Patients are admitted through the Psychiatry OPD service and rarely, directly from EMOPD/Ward or other hospital inpatient units
The admitted patient is received in the ward by the staff nurse on duty and the SR I/C of the ward is informed, who allots the case to one of the JRs posted in the ward
The JRs undertake the detailed history and examination of the admitted patient and discuss with the ward SR during the evening rounds. The JR then presents the case to the faculty during the ward rounds
Instructions for the nursing staff, including the medicines prescribed, are put down in writing in the instruction book. This is kept in the nursing station with the staff nurse on duty. Similarly instructions for administration of ECT, high risk management, vital monitoring more frequently than done routinely and any special instruction pertaining to the patient also must be issued in writing in the instruction book
The patient once admitted comes under the total care of the JR to whom the allotment of case is made. The JR is responsible for the management and care of the patient under supervision of the SR and faculty

Responsibilities of SR in the Ward
Ward SR is the main coordinator and overall I/C of the Ward Must reach Ward by 8.00 AM in the morning (on the day of academics which SRs are supposed to attend by 9.15 AM)

Case management

Following admission of a patient to the ward, the ward SR must:

Receive the patient at admission
Assess the severity of illness of the patient
Prioritizing the needs of patients and manage accordingly
Write an admission note
Exercise his judgment while allotting cases to JRs keeping the condition of the patient and seniority of the JR in mind
Management related decisions and management proper is to be undertaken by the SR and patient management must not be left to the JR alone because JR is a trainee
Should put notes in case file periodically (at least twice a week)
Ensure that PAC is done prior to the initiation of ECT
Should contact the concerned faculty member providing details with respect to progress of the patient
Should be available 24 X 7 on phone to the faculty or the ward in matters related to patient management
Should conduct evening service rounds and guide JRs in carrying out treatment of the patients
Should supervise the JR for writing and finalization of the Discharge Summary within a week of the discharge
Follow up the patient after discharge, guide JRs and discuss with faculty I/C of case

(SR must see the discharged patient and put a comprehensive note at least once in three months)

Evening teaching of JRs: to teach fundamentals of history taking, MSE and any topic related to management of the case
To guide JRs in presenting any ward-admitted case in CC /Students Clinical Meeting/Psychosomatic Rounds and psychotherapy forum
Prepare roster for lectures, seminars, CC, evening SR class, emergency/call duty roster (of JRs, SRs and faculty) in liaison with Faculty I/C of the residency training programme and HOD
Maintain inpatient Psychotherapy Register in which residents record the beginning, ongoing sessions and terminal dates of psychotherapy for all cases under them
Maintain a Register for Faculty Resident meeting (every 2nd Thursday of month)
Coordinate and conduct ward administrative meeting once a month in liaison with ward Faculty I/C
Supervise regular entry of data of inpatients in SPSS files
Be responsible for adequacy of record keeping in ward (case files, discharge summary, dispatch of file to OPD)
All important administrative issues must be informed to HOD through concerned Faculty member/s
Intimate daily by 10.00 AM, the exact number of vacant beds to OPD SR Room 208
Effective communication and coordination among SRs of Ward, OPD Room 205, Room No. 208 & C-L service is to be ensured

Service Responsibilities of JR in the Ward

Total management and care of the patients under his/her charge under supervision of the ward SR and Faculty I/C
Must attend allocated patients‖ problems even after-duty hours
In-patient record maintenance in accordance to the specified rules
In extraordinary situations, when asked by SR to stay for night duty in the ward
Any other responsibility that may be entrusted by the SRs in the interest of better patient care

When a patient is sent from OPD for admission, the outpatient record sent along with him/her should contain the following:

Admission form
Income declaration form/poor-free-treatment documentation
OPD card on which orders for admission are indicated
Admission referral form
Face Sheet recording socio-demographic details
Walk-In history sheet
OPD work up file if available (except in cases of Emergency admission when there should be a detailed admission note)
Psychiatry number except in those cases who are not admitted through psychiatry OPD e.g. admission from the general Emergency of PGI or transfer from other Wards of PGI.

In such cases, psychiatry number should be sought next morning from the OPD‖s social worker Records should be maintained in the appropriate file cover and neatly arranged in the following order:

Admission form
Income declaration form
OPD card
OPD face sheet
Walk-In sheet
Admission Referral form
OPD work up
In-patient work-up history and notes
Investigations reports
No dues form

Essentials of Record-Keeping in the Ward

There must be an admission note or D/W/U written in the file within 24 hours of admission of the patient to the ward
Guidelines for history taking should be followed for writing the D/W/U. Discussion of the case with Faculty and his/her opinion must be entered
Progress note for each patient needs to be written daily. It must contain patients current mental and physical status in brief, bio-functions, any investigations done and their reports, any change of medications, any side effects observed, need to mention whether patient had undergone any psychotherapy/ECT sessions
There should be a record of detailed MSE at least twice a week
SR of the Ward should put his/her notes at least twice during admission
Residents should write a pre-discharge counseling and discharge note along with the advice given at discharge
Discharge summary should be written within 48 hours of the discharge of the patient. One copy of it should be attached with the file and one should be submitted to the Psychiatry office for record keeping
File should be maintained neatly with all the papers and investigation reports etc. arranged sequentially
A separate page should be used for maintaining the treatment record with the dates of change in treatment
Required details of each patient should be entered in the Ward Register
If a case is transferred to another JR a clear handing over note should be written by the previous JR or the SR. Likewise the Resident taking over the case should write down a proper take over note
At the time of dispatch/ prior to dispatch of file to the record room completed files should be signed by the Consultants after duly filling the final diagnosis and length of hospital stay etc
All in-patient records must reach the record section in OPD without fail within one-two weeks of the discharge of patient
Timely entries must be made for all Psychotherapy cases in the Psychotherapy Register kept with the SR Psychiatry Ward

Role of PSW

Clinical Work Assignments

To assess psychosocial work up and interventions as per the format of all the patients admitted in the ward. To attend ward rounds daily and present work up in the ward rounds as per the case needs and the interventions carried out. Would be doing all these as per the instruction/ decision taken in clinical rounds in collaboration with JR and SR I/C of the case
Would be involved in different activities related to patient care in the ward like admission counseling, discharge counseling, activity scheduling of the patient, group therapy etc
To assess the needy patients for poor free status and facilitate the same if there is a need
To organize, supervise and regularly participate in group educational meetings, group ward activities for the patients in ward
To enter the data of assessment and interventions, follow-ups into the SPSS data base in ward on a day to day basis
Participate actively in the follow-up of the cases (through telephone, home visits etc.,) and record the same in the file. They should keep all the discharged cases in active surveillance and call them or visit their home if they do not turn up for follow up after two weeks or as assigned by the consultants. They should continue doing planned intervention and inform the consultants regularly. If new issues arise they should be immediately brought to notice of the concerned consultants
To arrange and do home visits, meeting with employers, visiting workplace, rehabilitation services, legal services etc., for the patients assigned to them by various faculty members
To attend various camps, attend courts and educational programs organized by the Department
Liaison with hospital authorities to facilitate poor free status, supply of free medications,
liaison with MSWs of other Department s for treatment of patients etc
Attend the Departmental Academics –CC, Seminar (Whole Departmental and specialty section). Can actively contribute for their part of assessment and intervention
May be assigned teaching responsibilities for various educational courses run in the

Institute like physiotherapy, speech and audiology

To participate in the research projects of various faculty members
To take initiative in conducting research under the guidance of faculty members

Administrativ

May be assigned clinical and administrative tasks as per the need of the Department
To attend various Departmental administrative meeting
To organize and procuring medicines for community camps