Why does only psychiatry have to suffer through MTPs? Oh, insurance. MTPs are completed electronically using CareConnect by Day 7 of admission and are required for all inpatient and PHP sites. Adolescent PHP tends to have the most rigorous review of treatment plans and will likely provide extensive feedback. There are components of the MTP that should be completed prior to treatment planning rounds and will be completed by different members of the treatment team (RN, SW, OT, RT). MTPs are a requirement of the Joint Commission and the hospital can lose accreditation if these are not done.
On admission, RN will select a primary problem (i.e. aggression towards others), and you will open the problem and fill in the corresponding sections:
- Problem Behavior Manifested By (MD enters in the treatment plan after team discusses this in daily rounds, see below)
- Long Term Goals (MD enters in the treatment plan after team discusses this in daily rounds, see below)
- Short Term Goals (MD enters in the treatment plan after team discusses this in daily rounds, see below)
- Each Discipline’s Interventions (each team member writes and either enters directly into MTP or emails to MD to enter into MTP, see below)
PROBLEM BEHAVIOR MANIFESTED BY:
Enter specific information about patient’s presentation.
- What specific behaviors indicate that the patient is experiencing the presenting problem?
Example: #
| NO: Psychotic Behavior Manifested by: Religious preoccupation, paranoia, and poor ADLS * If using any checkbox items, they must be explained in the comments section |
| YES: Psychotic Behavior Manifested by: 1) Charles states that he is the “new savior”; he has been spending increasing time on satanical websites. 2) He told his family that believes that he is being monitored by homeland security, is seen by hospital staff looking over his shoulder when speaking. 3) He has not bathed in at least 4 days. 4) he has been refusing to take his medications for 3 weeks (at baseline, he is medication compliant) |
LONG TERM GOALS:
This is a goal the team would like the patient to achieve by DISCHARGE. Goals need to be:
- Measurable (concrete criteria for measuring progress)
- Observable (What behaviors will you observe that indicate that the patient is achieving this goal?)
- Realistic (write what is possible for the patient to achieve during the hospitalization).
- Time bound (when do you expect this goal to be achieved by?)
- Linked to the problem
Example: #
| NO: Prescribe and manage medication, Order and interpret results of structural (plain X-ray, CT, MRI) imaging studies as indicated, Listen and validate patient’s feelings, |
| YES: MD will meet with patient 1:1 (modality) daily (frequency) and will teach the patient about the likely benefits of Zyprexa. MD will speak with patient and family about ways to help the patient manage possible side effect of increased appetite by teaching them to offer the patient low calorie foods. |
SHORT TERM GOALS:
These are goals the team would like to see in the next few days/in the next week (if hospitalization will be longer than a week)
These goals too need to be:
- Measurable (concrete criteria for measuring progress)
- Observable (What behaviors will you observe that indicate that the patient is achieving this goal?)
- Realistic (write what is possible for the patient to achieve during the next few days/week).
- Time bound (when do you expect this goal to be achieved by?)
- Linked to the problem
Example: #
| NO: Family will verbalize an understanding of the need for medication to treat patient’s psychotic symptoms. Have a reality-based conversation with staff once each shift |
| YES: By the time of the next treatment plan, 1) Charles will attend a wellness group 3 times this week and will be able to repeat 1-2 topics discussed in the group related to how engaging in self-care will help keep him out of hospital. 2) Charles will identify 1-2 reasons he has stopped taking his medications and will articulate this during daily team meeting. 3) Charles will take a shower every day with encouragement. |
Remember: For each goal the team identifies, the team must show evidence they are working toward completion of that goal.
INTERDISCIPLINARY INTERVENTIONS:
This is HOW you, as an: MD, RN, OT, RT, or SW are going to help the patient achieve the goals set out above. Each discipline brings their own method of helping the patient achieve their goals. This is your opportunity to share all the wonderful work you will do with the patient! It’s helpful to include active verbs like “teach,” “engage,” “educate,” “plan,” etc.
Interventions must include:
- Frequency
- Modality
- Focus
Example: #
| NO: Prescribe and manage medication, Order and interpret results of structural (plain X-ray, CT, MRI) imaging studies as indicated, Listen and validate patient’s feelings, focus on coping skills. (Avoid writing a job description of activities or interventions you are expected to do with every patient). |
| YES: MD will meet with patient 1:1 (modality) daily (frequency) and will teach the patient about the likely benefits of Zyprexa. MD will speak with patient and family about ways to help the patient manage possible side effect of increased appetite by teaching them to offer the patient low calorie foods. |
| YES: CSW will speak with the patient 1:1 2x and with the family in person 1x this week to educate about options for aftercare programs, including the UCLA Thought Disorder Intensive Outpatient Program. CSW will engage patient in 2 groups about discharge planning with focus on importance of self-care. |
| YES: OT will engage the patient in 3 task groups this week to assess Charles’ ability to follow directions, and to encourage completion of tasks. |
| YES: RN will work 1:1 with Charles to assist him in bathing daily, and to brush his teeth 2x daily, and will offer verbal praise after he completes each ADL. RN will engage Charles 3x weekly in wellness groups and will teach him about the importance of medication adherence. |
| YES: RT will engage the patient in 3 leisure groups this week to assess Charles’ ability to identify leisure interests, and to expose him to new recreational/social activities to offer distraction from his distressing thoughts. |
Progress notes should relate to the interventions each discipline stated they would make that week.
Creating the MTP note:
- Click “Master Tx Plan” heading and then click the “+Create Note” Select “IP NPH Master Treatment Plan Note”
- In the “MTP Notewriter”, click “Generate Treatment Plan” and wait patiently as it uses the information from the “Targeted Behaviors” section to fill in most of the information
- Switch to “Note” view, select you attending as Cosigner and fill in every section with “***”
- Tips:
- ‘Deferred Problems:’ are usually “None”
- Planned Consultations: if any
- ‘Next Review due on:” is always in 1 week
- ‘BIO-PSYCHO-SOCIAL FORMULATION’ should be individualized
- ‘TEAM MEMBERS PRESENT’ should include the names of the people who attended rounds that day with their credentials (MD, RN, LCSW, OT, etc)
Treatment Plan Updates:
Each week, the team members need to assess:
- Whether the Long Term Goals for that problem have been met
- Whether the Short Term Goals have been met
- What, if any changes to the interventions are being made (Changes to the type of intervention, modality, or frequency)
- Whether there is a NEW PROBLEM that needs to be added
- There are sections about falls, and about seclusion/restraint events, but any significant events (e.g., significant medical events) should be included in the treatment plan.
- Keep in mind whether there have been any FALLS since the last If there have, they should immediately be added to the Treatment Plan along with a care plan for preventing future falls.
- Have there been any SECLUSION/RESTRAINT events? If there have, they should immediately be added to the Treatment Plan along with a care plan for preventing future seclusions and restraints.
- Please follow this format for registering weekly updates: “Date (Author) – …” to produce a running list of the updates to track progress.
Creating the Treatment Planning Update (TPU) Note
- Similar to MTP, but under “Tx Planning” tab, you’ll now click “Update”
- Click “Master Tx Plan” heading and then click the “+Create Note” Select “IP NPH Treatment Plan Update”
- In the “MTP Notewriter”, click “Generate Treatment Plan” and wait patiently as it uses the information from the “Targeted Behaviors” section to fill in most of the information
- Switch to “Note” view, select you attending as Cosigner and fill in every section with “***”
- Tips:
- Next Review due on:” is always in 1 week
- ‘TEAM MEMBERS PRESENT’ should include the actual names of the people who attended rounds that day with their credentials (MD, RN, LCSW, OT, etc)