Sign Out Guidelines – Inpatient Psychiatry Today

Melrose Wakefield Department of Psychiatry

Sign-out guidelines

Sign-outs are brief synopses of your patients which will be used by on call doctors to help them quickly round on patients and make good treatment decisions. On call doctors typically print out the sign-outs and use them while interviewing patients, adding their own notes and using these as the basis for documenting visits in Meditech.

Sign-outs should generally include the following elements:

Name
Room # (helpful for on call docs to quickly find patients during rounds)
Legal status
Demographics (age, gender, race)
Diagnoses
Brief description of circumstances of admission
Brief description of current meds and response so far (no need to list all meds and doses since docs can get this from Meditech; instead, focus on the one or two main meds being used in this admission to treat target symptoms)
Any other current psych or medical issues
Treatment Plan: The treatment team’s over all plan and anticipated discharge date (This helps the on call doctor, since many patients will ask them when they are being discharged and what the plan is).
To do: What you would like the on call physician to actually do over the weekend. Typical examples are: titrate or taper a medication; check a medication level; monitor for specific side effects, etc… There may not be anything to do, in which case you can say “NTD”.

Sign-out Examples

-John Smith (Rm 641, DOA 1/8, section 12): 41 yo SWM, resident of a group home, with neurocognitive disorder and schizoaffective disorder, and with medical history significant for PE, afib (on Coumadin). Patient was admitted secondary to suicidal ideation specifically making statements about running into traffic (though he has limited mobility-he uses a walker). Currently on Risperdal and Zoloft. Using Trazodone for sleep. Mood is improving. Treatment plan is to gradually increase Risperdal and to refer patient for a rehab placement, probably discharge next week.

To do: Increase Risperdal to 2 mg HS on Saturday. Monitor for EPS from Risperdal, add Cogentin if needed.

-Jane Jones (Rm 632, DOA 1/10, CV): 29 yo SWF with chronic history of alcohol use disorder and unspecified mood disorder who presented to the ED secondary to worsening depression, SI and requesting detox from alcohol. Has been on CIWA since admission, receiving Librium as needed. On Lamictal 25 mg PO Q HS, Vistaril prn anxiety, Clonidine 0.1 mg BID PRN added on Monday (pt did not find it helpful), so Buspar 5 mg PO TID was added for anxiety.

To do: Monitor for s/e of dizziness from Buspar, adjust dose as needed.