Advice for starting new job in outpatient

Lizlaw · Nov 30, 2016

I can't be of any help but am looking to move from psych ER to outpatient psych and look forward to the comments on this post. Best of luck to you on your new job!

Davey Do · Dec 3, 2016

Lots of medication management... Other than reviewing like crazy the medication classes, side effects, and common labs to order, any other things to review that will help me be successful?

Very good preparation for your new position, oceanblue!

Treatment non-compliance, specifically with their medications, is one of the biggest reasons psychiatric patients in the community experience an increase in symptoms and need to be admitted to an inpatient program.

The two community mental health clinics I worked with from 1996 to 2003 had patient assistance and sample medication programs. At the time I took over these programs, they were in chaos. A system of coordinating these two programs allowed the nurses and psychiatrists to sign out sample medications provided by the drug reps. The client would be assisted in applying for an assistance program where they could get their expensive medication free, or at a substantially reduced price. The clients were often given a supply of sample meds until their assistance program kicked in.

The community mental health clinic in which you will work probably has some form of these two programs. Knowing and utilizing these programs in an endeavor to keep the clients medication compliant will decrease the likelihood of an exacerbation of, for example, psychotic symptoms.

Good luck to you oceanblue in your new position!

oceanblue52 · Dec 3, 2016

The two community mental health clinics I worked with from 1996 to 2003 had patient assistance and sample medication programs. At the time I took over these programs, they were in chaos. A system of coordinating these two programs allowed the nurses and psychiatrists to sign out sample medications provided by the drug reps. The client would be assisted in applying for an assistance program where they could get their expensive medication free, or at a substantially reduced price. The clients were often given a supply of sample meds until their assistance program kicked in.
The community mental health clinic in which you will work probably has some form of these two programs. Knowing and utilizing these programs in an endeavor to keep the clients medication compliant will decrease the likelihood of an exacerbation of, for example, psychotic symptoms.
Good luck to you oceanblue in your new position!

Wow that is really great advice Daley Doe thank you! As a newish grad I have some theoretical notion about programs like these, but wouldn't have thought to be really proactive. Makes sense though, advocating for our patients to get the resources they need is so important. Looking forward to this role...I feel like people think Psych is easy without realizing that all the medical side effects (e.g TD, EPS, agranulocytosis, decreased WBC, etc.), coupled with dealing with the psyche make it one of the more challenging nursing professions. Just my feeling from being in the Psych field so long and dabbling in acute inpatient. Appreciate the encouragement thus far!

Meriwhen, ASN, BSN, MSN, RN · Dec 3, 2016

Davey Do covered it all.

Keep in mind that outpatient doesn't always mean "stable." Patients can and do decomp, and you have to be aware of the signs of that happening and how to determine whether a higher level of care is necessary. Is your outpatient clinic affiliated with a hospital (psych or otherwise)?

Davey Do · Dec 3, 2016

Daley Doe thank you!

You're welcome and you've caused me to consider changing my username, oceanblue!

Davey Do · Dec 3, 2016

Is your outpatient clinic affiliated with a hospital (psych or otherwise)?

Excellent question, Meriwhen!

An affiliation with a hospital can benefit the client who has to go into inpatient treatment numerous ways. The community mental health clinic can provide the hospital treatment team with a client's history, provide support during the hospitalization, and be an integral part of the discharge and follow up process.

As the nurse on an ACT team with a community mental health clinic, I was allowed to provide and receive information, and be involved in the treatment process, without going through a lot of rigmarole because the clinic had a contract with the hospital.

It was a win-win situation.

oceanblue52 · Dec 6, 2016

Davey Do covered it all.
Keep in mind that outpatient doesn't always mean "stable." Patients can and do decomp, and you have to be aware of the signs of that happening and how to determine whether a higher level of care is necessary. Is your outpatient clinic affiliated with a hospital (psych or otherwise)?

That is a good question and one of the first topics I had in mind to ask about at orientation. I don't think so but I think it's largely systemic as my state is severely lacking in inpatient beds. CPI has given me a pretty good framework for the early behavioral signs that escalate to acting out, so I'm hoping that combined with working inpatient and monitoring patients throughout the course of their hospitalization will prove helpful. Any other things to keep in mind? Have been reviewing AIMS and looking at some threads about doing Prior Auths...really helpful points!