SOP_NUMBER: 508.31-att-1
TITLE: CSU_ACU Daily Nursing Clinical Assessment
WORD_COUNT: 299
URL: https://gps.press/sop-data/508.31-att-1/
ATTACHMENTS:
1. CSU_ACU Daily Nursing Clinical Assessment
URL: https://gps.press/sop-data/508.31-att-1/
2. Crisis Stabilization Unit Psychiatric Admission Form (M70-02-02)
URL: https://gps.press/sop-data/508.31-att-2/
3. Abbreviated Psychiatric Admission for CSU (M70-02-03)
URL: https://gps.press/sop-data/508.31-att-3/
4. Crisis Stabilization Unit Treatment Plan
URL: https://gps.press/sop-data/508.31-att-4/
6. Crisis Stabilization Unit Discharge Summary
URL: https://gps.press/sop-data/508.31-att-6/
7. Crisis Stabilization Unit Admission Log
URL: https://gps.press/sop-data/508.31-att-7/
8. CSU Referral Report (M70-02-08)
URL: https://gps.press/sop-data/508.31-att-8/
9. CSU Discharge Summary Note (Form M70-02-09)
URL: https://gps.press/sop-data/508.31-att-9/
10. Crisis Stabilization Unit (CSU) Admission Cover Page
URL: https://gps.press/sop-data/508.31-att-10/
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FULL TEXT:
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SOP 508.31
Attachment 1
12/9/19
|CSU/ACU Daily Nursing Clinical Assessment|Col2|
|---|---|
|
This assessment should be done on each CSU/ACU
patientdailyon Saturdays, Sundays, and holidays.
The information is to be relayed to the on-call
psychiatrist when he/she calls in and you should write
the psychiatrist plan of action for the offender in the
space provided. This will include any orders given.
(nursing staff will not be allowed to accept “standing
orders”; i.e., if ‘x’ happens, do ‘y’, etc.) *All orders
must be written on a physician order form.|
Facility: ________________________________
Offender: _______________________________
GDC ID#: ______________________________
DOB: __________________________________
Race: _____________ Sex: _______________
Date: __________________________________|
|**Pertinent Information**
Date of Admission:___________________ Reason for Admission:_______________________________________
_____________________________________________________________________________________________
Mental Health Diagnosis: _______________________ Status (i.e., SP, restraints): __________________________
_____________________________________________________________________________________________
Medication(s) and Dosage: _______________________________________________________________________
_____________________________________________________________________________________________
Allergies: _____________________________________________________________________________________
Medication Adherence while in CSU/ACU: __________________________________________________________
Mental Status: _________________________________________________________________________________
_____________________________________________________________________________________________
Offender Complaints: (to include physical health complaints): ___________________________________________
_____________________________________________________________________________________________
Referred to Medical for physical health: [ ] Yes [ ] No
Vital Signs: T___________________ P_________________ R________________ B/P____________________
Attitude: ______________________ Change in Behavior: _____________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Appetite: ______________________________ Orientation: ____________________________________________
Suicidal/homicidal thoughts or acts: ________________________________________________________________
Sleep Pattern while in CSU/ACU: _________________________________________________________________
|**Pertinent Information**
Date of Admission:___________________ Reason for Admission:_______________________________________
_____________________________________________________________________________________________
Mental Health Diagnosis: _______________________ Status (i.e., SP, restraints): __________________________
_____________________________________________________________________________________________
Medication(s) and Dosage: _______________________________________________________________________
_____________________________________________________________________________________________
Allergies: _____________________________________________________________________________________
Medication Adherence while in CSU/ACU: __________________________________________________________
Mental Status: _________________________________________________________________________________
_____________________________________________________________________________________________
Offender Complaints: (to include physical health complaints): ___________________________________________
_____________________________________________________________________________________________
Referred to Medical for physical health: [ ] Yes [ ] No
Vital Signs: T___________________ P_________________ R________________ B/P____________________
Attitude: ______________________ Change in Behavior: _____________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Appetite: ______________________________ Orientation: ____________________________________________
Suicidal/homicidal thoughts or acts: ________________________________________________________________
Sleep Pattern while in CSU/ACU: _________________________________________________________________
|
|
Psychiatrist Name: ________________________________________ Date: _____________ Time: ___________
Plan (to include new orders given): ________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Fax Number to fax orders for signature: _____________________________________________________________
_____________________________________________ ______________________________________
Signature Title
|
Psychiatrist Name: ________________________________________ Date: _____________ Time: ___________
Plan (to include new orders given): ________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Fax Number to fax orders for signature: _____________________________________________________________
_____________________________________________ ______________________________________
Signature Title
|
Form no. M70-02-01 Page 1 of 1
Retention Schedule: Upon completion, this form shall be placed in the offender’s medical file (Infirmary Section with CSU/ACU packets) and
retained for ten (10) years.