ECT documentation checklist
(,X,R (refused) or N/A))Patient's Name:
Prefers to be called:
SESSION:
1 / 2 / 3 / 4 / 5 / 6
DATE: / ward / ECT / ward / ECT / ward / ECT / ward / ECT / ward / ECT / ward / ECT
- If the patient is giving an informed consent:
(a) Has the patient signed the Trust's consent form 1b?
(b) Does the consent form 1b state maximum number of treatments to be given? (ensure this number has not been exceeded)
(c) Has a psychiatric doctor signed to indicate that they have explained procedures, benefits and risks to the patient?
(d) Is the patient consenting to ECT treatment today?
(e) If the patient is under 18 years and consenting to ECT is form T5 present? (applies whether patient detained or non-detained)
(f) Does Form T5 state maximum number of treatments to be given? (ensure this number has not been exceeded)
2. If the patient lacks capacity to consent to ECT treatment:
(a) Has the 2nd medical opinion been secured to administer ECT treatment?
(b) Has the Trust's consent form 4b been completed?
(c) If the patient is an informal patient has an MC1 form been completed?
3. If the patient is detained under MHA 1983, & giving an informed consent:
(a) Check that (a) to (d) of section 1 above has been completed and (e to (f) if patient is under 18
(b) Is Form T4 present? ( FormT4 only used if patient over 18, see 1(e) above if patient under 18)
(c) Does Form T4 state maximum number of treatments to be given? (ensure this number has not been exceeded)
4. If the patient is detained under the MHA 1983 & lacks capacity to consent:
(a) Is Form T6 present? (As a matter of good practice the Trust's consent form 4 should also be completed)
(b) Does Form T6 state maximum number of treatments to be given? (ensure this number has not been exceeded)
5. Urgent Treatment - If the patient is detained in hospital under the MHA 1983 & being given ECT as an emergency (includes SCT patients recalled to hospital)
a) Is Section 62 documentation present?
6. If the patient is subject to SCT & not recalled to hospital
a) Is form CTO 11 present?
7. Is the ECT prescription valid?
(a) Signed?
(b) Dated?
(c) States uni/bi-lateral (as per consent form 1b if applicable)
(d) Has today's treatment been prescribed?
8. Is there a record of discussion with a relative?
9. Is there a record of weekly patient review in medical notes? (Relevant to prescription of ECT)
10. Has patient’s status changed (eg Section rescinded, placed on Section MHA) since last treatment?
11. If SectionMHA rescinded is discharge from Section form present and signed?
12. If status has changed, has consent been re-addressed?
Comments:
Signature:
Northumberland, Tyne and Wear NHS Foundation Trust
App 9 – ECT Documentation Checklist- V03 – Issue 1 – Issued Apr 16
Part of ECT-PGN-01-Integrated care pathway for source Electro-Convulsive Therapy -NTW(C)51-ECT Policy