No direction on Chemical Dependency Unit

[mare4322]

I've been working on a chemical dependency unit for 1 1/2 years. We do not do detox, as pts. are detoxed on one of our psych units then transferred to us. On my unit we have Residential Treatment and Partial Hospitalization programs. I am the only nurse for any 24 hr period and I only work from 9a-1p M-F. We have no secretary and we don't get a tech for 7-3. We've had up to 16 pts. at one time. But a tech is not in our numbers. So, I do the answering of phones, escorting pts., write notes on all pts., take off orders, treatment plans, run to medical records, run to admitting, get the UDS's, call the doc's, etc. 3-11 consists of one tech and 11-7 consists of one tech. The techs are by themselves. I work with a counselor who has a full plate too. The medical director of the hospital just recently had a patient on our unit. He was upset because his pt. was discharged from residential and admitted to Partial by a doctor who was on call for him. He asked if the physician had come to see the pt., I said no, he did not. He then wrote in his note in the chart that we had failed to get the patient reassessed. The Medical Director then talks to my boss about it and next thing you know, we, (the counselor and me) are getting pulled into a meeting informing us that we must have a physician order, not a verbal physician order, when the pt. comes to us. Of course nothing was said as far as how we are going to accomplish this. Our charting wasn't correct either. We are supposed to do BIRP charting. Who knew? My boss has done nothing to train us on what we are doing wrong and how to do it right. He just doesn't know and just deligates to us I feel like I don't have any direction and there is truely no one for me to ask. I've asked for PHP policy and procedures book and they act like I'm trying to get ahold of some great secret. I don't think that they have one. Does anyone know where I might find the state regulations on Partial Hospitalization and Residential Treatment Program? I'm so mad at being put in this position.

[Thunderwolf, MSN, RN]

I would encourage you to contact your state mental health board for answers. That board can point out to you or even provide you the regs. You may also contact your state drug and alcohol board if you are concerned about regs in this particular area.

Until then, here is a site that may be helpful:

http://www.state.tn.us/sos/rules/0940/0940-05/0940-05-33.pdf

Peace