Professional Services, Broughton Hospital...Printable

Professional Services at Broughton Hospital support and abide by the values reflected in Broughton Hospital's Mission and Vision Statements, and thus reflect a "compassionate concern for the whole person with recognition of the dignity and worth of every person served." Programs offered by individual disciplines are integrated with other components of active treatment and operationalized in the hospital's mission, enabling the individual to re-establish himself and function in the community as a productive citizen.

Serving patients from adolescent through senescence, departments plan for the individual patient through interdisciplinary team planning process. Drawing from the variety of skills and knowledge of representatives from individual professional disciplines and input from paraprofessionals, patients, and families or significant others, as appropriate, the Hospital implements individualized treatment planning for each patient. The treatment planning process addresses, in a comprehensive manner, the patient's assets and needs/problems from the point of initial contact and intake through active treatment and aftercare planning. The process is designed to ensure that the established treatment goals have continued appropriateness for the patient and services are provided in the least restrictive environment.

As an inpatient psychiatric treatment facility, the hospital provides Psychiatric Services to the entire patient population. This includes adolescents, adults, and elderly with severe, acute and persistent mental illness, as well as individuals with dual diagnoses. A significant number of patients have concurrent physical conditions/complications accompanying their mental illness. Treatment interventions for the majority of admissions are primarily focused on relief of acute symptoms, rapid stabilization, and re-entry into the community for further treatment and follow-up. For patients assessed as needing continuing inpatient treatment, interventions are focused on rehabilitation of skill and functioning maintenance. A variety of service models are available ranging from psychosocial to maximum care. Immersed in each treatment program component are provisions to meet physical needs of the patients. Patients may move from one treatment program component to another based on identified needs, accomplished through referral and screening mechanisms. Psychiatrists are responsible for the integration and overall management of the majority of patients.

Major psychiatric services include:

Psychiatric assessment (needs, strengths, problems, and initial treatment) and evaluation (comprehensive mental status).
Psychiatric diagnoses
Determine immediate treatment and subsequent treatment.
Select and monitor efforts of pharmcotherapeutic agents.
Monitor, evaluate, and integrate treatment modalities with documentation of attention to patient's response to treatment and progress therein. In this role, the psychiatrist functions as a member of an interdisciplinary team.
Patient safety, particularly related to special treatment procedures, i.e., use of psychiatric restraint, seclusion, isolation time-out, electroconvulsive therapy, suicide precautions, etc.
Determine readiness for discharge.
Coordinate post-discharge planning.

A significant number of patients who are admitted for psychiatric services have concurrent physical problems. Under the auspices of Medical Services, history taking and physical examinations are performed on patients within 24 hours of admission. At that time, appropriate laboratory tests are ordered, as necessary, for diagnostic studies. Minor problems that do not require hospitalization in an acute medical setting are treated on the patient's residential (psychiatric) service/ward by the attending physician in consultation with a specialist, if necessary. Consultative services are provided regularly and as-needed in the specialty fields of orthopedics, radiology, pathology, oral surgery, ophthalmology, urology, dermatology, ENT, internal medicine, neurology, and OB/GYN (wherein prenatal and post natal care are rendered. Patients are sent for delivery to Grace Hospital in Morganton, NC.) Acutely or critically ill patients in need of hospitalization are admitted to the acute medical ward for diagnostic studies and treatment. In case of emergencies that are beyond the capability of Broughton Hospital, patients are transferred to nearby Grace/Valdese Hospitals on a referral basis and are transported by EMS. The hospital also provides laboratory, radiology, including nuclear medicine, respiratory care services and EKG and EEG laboratories.

Nursing Department endeavors to provide quality care for patients by:

Providing the unique and specialized professional service of nursing on a 24-hour basis.
Conducting initial and periodic assessments of the nursing needs of patients.
Planning nursing care in an individualized and realistic manner reflecting current standards.
Utilizing multiple nursing strategies to address the needs of individual patients as well as groups of patients, with emphasis on:

- assisting patients to meet philosophical and psychological needs;
- assuring patient safety/security;
- utilizing the milieu to promote health adaptive experience;
- providing health education to patients and their significant others;
- methodically evaluating the effectiveness of nursing care provided;
- assuring the general ward environment/systems are conductive to efficient and effective delivery of patient care services;
- advocating for patient needs to be addressed within the healthcare system;
- collaborating effectively with others of the healthcare team;
- providing knowledgeable, skillful, trained, motivated nursing staff; and
- collaborating with institutions of higher education to provide learning opportunities for students in health care programs.


	Nursing ascribes to standards of care to ensure that a competent level of nursing care is provided to all patients. Standards also guide professional behavior in the nursing role. The essential elements of the Nursing Department are detailed in nursing policy.

Social Work Department provides a broad array of services. These services are primarily focused to assist the patient and family to achieve normal living, while safeguarding human and civil rights and fostering dignity and personal growth. The center of focus is to enhance the coping capacity of each person served, enabling the individual to assume responsibilities in life’s activities. The social work mission is accomplished through, but not limited to, the following:

Admission Services; Upon admission the social worker:

- interviews the patient,
- notifies families, with appropriate consent, and guardians
- obtains psychosocial history from family and involved community resources,
- develops tentative discharge plans, identifying initial discharge issues,
- assesses the needs of the patient to assist in developing a unified plan of care,
provides patient/family education (through all phases of treatment)., as indicated

Interim Services: During the course of hospitalization, the patient is provided with numerous and varied forms of treatment in accordance with individual needs. The social worker, as a core member of the treatment team, provides:

- individual counseling/psychotherapy,
- family counseling/therapy,
- group therapy,
- patient/family education,
- information and referral and collaborative services,
- information and referral and collaborative services,
- discharge planning.


	Social work services are available to patients and their families in order to foster and facilitate maximum personal and social development, positive family functioning and effective and satisfying social and community relationships.

Therapeutic Recreation and Creative Expressive Arts provide multifaceted, structural activities to help patients test reality, exercise independence, re-establish social contact, learn new skills, restore self-confidence, and develop new ways to solve problems. These professional services contribute through leisure and therapeutic modalities the promotion of health, prevention of illness or future disability, and enhance the rehabilitation of persons with physical, social, and/or emotional disabilities. Services have two major thrusts: (1) Use of activities designed to meet individual needs as a form of treatment and (2) Ensuring that there is a sufficient variety of leisure recreation activities to meet the needs of a diverse adult and adolescent population. Therapeutic Recreation and Creative Expressive Arts services provide quality care to patients through:

Recreation therapy which uses activities specifically designed to improve, develop, and/or maintain physical, psychological, emotional, and/or social behaviors which assist individuals in establishing and expressing an independent life style;
Leisure education, which is activities, designed to assist patients to recognize the important benefits that can be derived from participating, on a regular basis, in recreation/leisure activities. Such uses value clarification activities that encourage individuals to identify attitudes, feelings, and beliefs in regard to participating in recreation/leisure activities;
Visual arts using the medium of drawing, painting, and sculpture to encourage disclosure and personal growth within the framework of the developed treatment plan of the individual patients;
Participation facilitates the expression, sharing, and understanding of the patient's problems and concerns.
Music therapy offers specialized application of music to accomplish therapeutic gains within a therapeutic relationship with the therapist to restore, maintain, and/or improve mental and physical health.
Dance movement therapy is designed to enable the patient to understand more about himself/herself through body movement. Making use of rhythm, forced time, breath, symbolic communication and ways of moving with intent.
Additional services that build on independence and support interests and leisure are offered through pet therapy, horticulture programs, Opportunity Center participation, centralized evening and weekend programs, and a transition into community-based services through participation in adult day service programs.


	Occupational Therapy is a health and rehabilitation profession which helps people regain, develop, and build skills that are important for independent functioning, health, well-being, and happiness.


	Occupational Therapy practitioners work with people of all ages who, because of illness, injury, developmental or psychological impairment, need specialized assistance in learning skills to enable them to lead independent productive, and satisfying lives. Occupational therapy helps individuals with mental illness achieve independence and community integration.


	Specific areas of intervention may include motor, sensory, cognitive, intrapersonal, interpersonal, activities of daily living, productivity, work, vocational and retirement activities.


	Evaluation includes the use of standardized and non-standardized tests and measurements to identify areas for treatment. Direct services include evaluation and hands-on treatment; other services may include consultation and education.


	Occupational Therapy intervention addresses function to (1) develop, maintain, improve, and/or restore performance; (2) compensate for dysfunction; (3) minimize or prevent debilitation; and/or (4) promote health and wellness.


	The department operates under standards developed by the American Occupational Therapy Association, the practice law of North Carolina, and abides by the Occupational Therapy Code of Ethics.

Physical Therapy provides a form of healthcare that prevents, identifies, corrects, and alleviates acute, prolonged movement dysfunction of anatomic or physiological origin. Services are designed to help in the restoration of function of those patients disabled by accident or illness to the highest level of comfort and "use of self" as possible. The greatest emphasis is placed on assisting the patient to become independently functional using physical agents such as exercise, modality, and education as opposed to drugs. The primary objective of physical therapy is to promote optimum human health and function. Plans for physical therapy are coordinated with the patient’s treatment plan and based on physician referral. Services are provided within the facility or by written arrangement by an outside clinician or facility, if necessary, to meet the needs of the patient. Equipment used in physical therapy services is of the quality and quantity that will provide safe and effective patient care. Written information regarding periodical calibration, maintenance, and service of equipment is maintained. Examples of services include:

Examination/evaluation including range of motion, manual muscle test, wheelchair, limited prosthetic orthotic and functional.
Therapeutic exercise including active-free, active-assisted, and passive range of motion; progressive isometric contraction, isotonic contraction, eccentric contraction, and proprioceptive neuromuscular facilitation (PNF), restrictive exercise, neurodevelopment treatment (NDT) techniques, and other activities to aid with reacquisition of fine and gross motor skills.
Chest physical therapy including postural drainage and chest percussion.
Locomotion including gait training and transfer techniques.
Physical agents including hot and cold modalities, electrical, sonic and radiant modalities, and mechanical agents of traction, compression, and percussion.
Education for patients and families on the nature of the disability and equipment needs.
Education for staff in the use of adaptive equipment and other subjects
. Coordination of prosthetic and lower extremity orthotic services. Patients needing prosthetic and lower extremity orthosis are referred to certified specialists who will provide fitting and follow-up.


	Standards of practice adhered to within the department are encompassed in the Code of Ethics of the American Physical Therapy Association and the Physical Therapy Practice Act of North Carolina.

Psychology Department provides an array of services including, but not limited to, clinical evaluation and therapeutic services for patients and families; consultation to hospital personnel and community agencies; training of hospital personnel, psychiatric residents, psychology interns and practicum students; and research, consultation on research design, data analysis, and dissemination of research findings. Services are provided in accordance with the standards and requirements for the provision of psychological services set forth by the American Psychological Association, Joint Commission of Healthcare Organizations, Health Care Financing Administration, and the North Carolina Statutes. In-depth information pertaining to specific psychological services is available in the department's policy manual.

Dental Department is designed to maintain oral health for the patient population. Patients qualify for dental emergency treatment regardless of their length of stay. Emergencies after regular working hours are treated. Patients are seen within one month of admission. The admission examination includes tissue examination (intra-oral and extra-oral), charting of existing restorations and decayed and missing teeth, dental histories, and review of allergies and medical findings. Patients with a continuous hospital stay of four weeks or more qualify for comprehensive dental care. Such includes preventive, prophylaxis, endodontics, restorative periodentics, oral surgery, and fixed and removable prosthodontics.


	Pharmacy Department provides comprehensive, progressive pharmaceutical services with responsibilities in administration, distribution, and clinical arenas. From the clinical services perspective, pharmacists or the pharmacy department provides:

Monthly drug regime reviews as required for the nursing facility patients.
Drug information and patient consultation to hospital staff upon requests.
Patient and family education and inservice training for hospital staff.
Monitoring of drug therapy including dosages, frequency of administration, drug interaction, food/drug interactions, incompatibilities, and allergies through utilization of computerized medication profile information and computerized clinical screening.
Formulary maintenance activities, drug usage evaluation activities, and adverse drug reaction monitoring activities through the Pharmacy and Therapeutics Committee.
Pharmacokinetic dosing assistance from aminoglycoside antibiotics and vancomycin.
Monitoring of WBC information and record keeping activities for patients receiving Clozapine.
Publication of a bimonthly newsletter.
Clinical pharmacy services in-patient care areas, which includes participation in rounds, drug therapy monitoring and interdisciplinary treatment teams. Documentation related to these services is included in progress notes.

Work Therapy is a treatment medium, which is carried out in the milieu of real work settings. Patients are paid for the work they perform in accordance with applicable Department of Labor Wage and Hour Standards. A variety of work assignments are available, ranging from simple to more complex responsibilities. Supervision may be provided by the Work Therapy staff or by other designated hospital employees.

The ultimate objective of Work Therapy is to provide work situations where in patients derive therapeutic benefits. This process contributes to the operation of the hospital while concurrently providing opportunities for the restoration, maintenance and improvement of patients' vocational skills as an integrated component of treatment.