Psych Nurse Practitioner - Crisis - Multiple Site

Psychiatric Mental Health Nurse Practitioner (Crisis / OSC Expedited Care)

Community Bridges, Inc. (CBI) is an integrated behavioral healthcare agency offering a variety of different programs throughout Arizona. CBI provides residential, outpatient, inpatient, patient-centered medical homes, medication-assisted treatment, and crisis services to individuals experiencing crisis, opioid use disorder, homelessness, and mental illness. At Community Bridges, Inc. (CBI), a psychiatric practitioner is an integral specialty for our whole person approach in our integrated system of physical, psychiatric, and addiction services. The scope of practice of psychiatric practitioner in the inpatient setting will see adults 18 and older, all genders, all socio-economic backgrounds, complex medical history, and co-occurring psychiatric disorders. Psychiatric practitioners at CBI will be expected to provide patient-centered, evidence-based care for patients as well as serve as patient advocates in all health-related matters, including the appropriate use of specialists, health services, and community resources.

CBI will be looking for PMHNPs for the following shifts:

• PMHNP/FNP – for Crisis Sobriety Center – AM/PM shifts (Sunday – Tuesday Rotating Wed) (Rotating Wed Thursday - Saturday).
• PMHNP – (SMI Caseload) -Full time on site, Mesa location; 8AM-4PM Monday – Friday.
• PMHNP – ACT/FACT – Full time on site, Central Phoenix 8Am-5PM Monday – Friday.

This document defines the skills, activities, and expertise that fall within the psychiatric practitioner's scope of practice in the inpatient and outpatient setting. General scope within their skills, competencies, and experience, licensed practitioner shall

• Complete Urgent Psychiatric and/or Addiction Medicine evaluations with all patients referred to the 23-hour observation unit from all referral sources including, but not limited to, hospitals, urgent care centers, law enforcement, and other medical practitioners for the purposes of assessment, diagnosis and treatment recommendations.
• Complete Urgent Psychiatric Assessment and/or Addiction Medicine, Ambulatory Detox, or Physical Health Assessments with patients who have been identified by CBI screening staff.
• Coordinate with one another when admitting, transferring, or discharging a patient to a different CBI program or level of care and will document in the medical record to ensure a smooth transition.
• Be available or initiate doc to doc communication and coordination of care and document it appropriately.
• All patients on the unit are evaluated at least daily to provide necessary adjustments in treatment and discharge planning.

Seclusion and Restraint:

• Seclusion and restraint interventions are used in accordance with CBI policy
• Provide assessment for the appropriate use of seclusion and restraint. Assessment includes documentation of staffing of current behaviors, known medical conditions, know psychiatric/behavioral health conditions and any current medication.
• Write an order immediately if at the facility, or sign order in the electronic health record within three hours if given verbally. Practitioner shall coordinate with the RN staff to confirm the date and time of intervention.
• When writing/signing order, the order shall include the following
• The date and time that the restraint or seclusion was ordered;
• The specific restraint or seclusion ordered;
• If chemical restraint is ordered, then the drugs ordered names, strength, dosage, route of administration, and symptoms being treated
• Maximum duration authorized is not to exceed three continuous hours.
• Complete and document an assessment within one hour after order for restraint or seclusion takes place, which shall include current behavior, reaction to intervention being used, patient's current medical condition, and whether to continue or terminate the restraint or seclusion
• Write a release order or document a second order at the end of three hours if restraint or seclusion needs to be continued

Discharge Orders:

• Review cases and discharge plans during rounds with assigned CBI medical staff.
• Document and sign full discharge orders and follow-up recommendations within 24 hours of discharge

In addition to meeting universal requirements, practitioner will:

• Remain on the unit for the entirety of the scheduled shift. Deviations require prior approval from the CMO or designee.
• Complete Application for Involuntary Evaluation and Application for Emergency Admission (please see a more detailed job aid). Application documents are reviewed by a qualified practitioner within two hours of receipt for acceptance decision
• Practitioner will immediately notify the Admission Coordinator of the decision
• Applications that are determined as not acceptable must be staffed with the CBI Medical Director prior to not accepting the application and prior to dropping the application post-evaluation

Admission Orders:

• Practitioner Admission Orders are completed on admission (in person or verbally to a nurse) and signed by the admitting practitioner within 24-hours of admission

Daily Staffing and Rounds:

• Everyone admitted to the 23-Hour Observation Unit will have a psychiatric evaluation at minimum once every 24 hours, or sooner if clinically appropriate and necessary to justify patient's need for continued stay
• Review cases with RN and Crisis Specialist during rounds as part of discharge planning process
• Document rounds in progress note
• Reviews cases with oncoming practitioner at the end of each shift.
• Maintain treatment of physical health and/or coordination with PCP and other prescribers while in treatment

Internal Consults and Coordination of Care

• Coordinate with one another when discharging, admitting or transferring a patient to a different CBI program or level of care and documents in the medical record to ensure a smooth transition

Psychiatric :

• Complete a psychiatric evaluation and documents the evaluation in the patient file for everyone admitted to the inpatient behavioral health facility
• Write order and/or signs order for a pain management evaluation, if clinically indicated, if outside the scope of the attending medical practitioner
• Provides necessary documentation and treatment for patients under petition or court ordered treatment

Discharge Orders and Plan

• Document and sign full discharge orders and follow-up recommendations within 24-hours of discharge
• Document review of discharge plan with the patient
• Mental Health/Psychiatric Care: evaluate each patient for ongoing mental health/psychiatric care prior to discharge and document in the electronic health record
• Physical Health: Practitioner shall evaluate each patient for ongoing physical health issues prior to discharge and document in the electronic health record

Universal:

• Complete orientation as directed by CBI, which includes shadowing another CBI practitioner prior to working with patients
• Complete a TB skin test prior to working with CBI patients and annually thereafter to ensure professional is free from tuberculosis. Test results must be submitted to the Credentialing department annually.
• Obtains and maintains suboxone waiver for to treat the maximum number of patients for which the practitioner is eligible.
• Maintains necessary patient data logs as required when treating patients with buprenorphine to coordinate with the medical practice team and clinical team on caseload size.
• Provides evidence of CPR/First Aid prior to working with CBI patients and provides documentation of renewal every two years. Evidence of CPR/First Aid renewals must be submitted to the Credentialing department.
• Participate in quality management initiatives and correct any identified areas of deficiency within 72 hours; exceptions must be approved by the Director of Medical Practice in consultation with the CBI Medical Director.
• Maintain a minimum 85% compliance with documentation requirements
• Not cancel patient appointments without prior notification to CBI
• Not refuse to see CBI patient(s) without approval from the medical director
• Adhere to the appointment scheduling protocols assigned by the medical director and monitored by the medical management team.
• Maintain a minimum of 75% follow-up rate
• Complete and document all medication assessments and informed consents by the end of assigned shift or within 24 hours of seeing the patient.
• Review the Controlled Substance Prescription Monitoring Program prior to treatment and coordinate care with other prescribing practitioners
• Utilize e-Prescribing for all patient prescriptions as established in the CBI electronic medical record
• Attend regular staffing and rounds on assigned patients; participate in the development of the patient's treatment plan; provide clinical expertise for the treatment team for patient care; give appropriate direction and providing effective communication about patient care activities