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Policies,Clinical,UW Health Clinical,General Care and Procedures,Procedures

Electroconvulsive Therapy (ECT) (2.3.1)

Electroconvulsive Therapy (ECT) (2.3.1) - Policies, Clinical, UW Health Clinical, General Care and Procedures, Procedures

2.3.1


UW HEALTH CLINICAL POLICY 1
Policy Title: Electroconvulsive Therapy (ECT)
Policy Number: 2.3.1
Category: UW Health
Type: Ambulatory and Inpatient
Effective Date: July 13, 2017

I. PURPOSE

To establish guidelines for the use of and procedures for Electroconvulsive Therapy at University of
Wisconsin Hospitals and Clinics (UWHC).

II. POLICY ELEMENTS

Electroconvulsive Therapy (ECT) is provided at University of Wisconsin Hospitals and Clinics (UWHC)
according to the policy and procedures established for its utilization. Other forms of convulsive therapy are
not administered at UWHC.
A. Only a physician or member of the UWHC medical staff who is privileged to perform ECT or a GME trainee
under his or her supervision shall administer electroconvulsive therapy.
B. There should be appropriate indications for administration of Electroconvulsive Therapy. Diagnoses suitable
for ECT include but are not limited to: Major Depressive Disorder, Bipolar Affective Disorder, and
Schizophrenia. The indications and necessity for ECT shall be documented in the physician's notes. The
indications noted in the medical record should include documentation of past treatment trials, severity of
current symptoms, and/or other clinical reasons that ECT is currently indicated.
C. Patients should be evaluated for non-psychiatric medical contraindications to ECT. Contraindications may
include: recent stroke or intracranial hemorrhage, intracranial lesion causing mass effect, unstable cardiac or
respiratory conditions, or other problems that would preclude the use of general anesthesia.
D. If the patient has decisional capacity, the physician must obtain informed consent for Electroconvulsive
Therapy from the patient, after the patient has been educated on ECT. Patient informed consent will be
documented by the patient's signature on the "Electroconvulsive Therapy (E.C.T.) Consent Form." The
medical record should also reflect documentation that the patient has had the opportunity to discuss with the
attending physician the risks and benefits of the procedure, alternative therapies available, and the risk of no
intervention, prior to giving consent.
E. If ECT is deemed appropriate for mental health treatment, based on the criteria discussed in sections II.B.
and C. of this policy, for a patient who lacks decisional capacity and, therefore, cannot give informed
consent to the procedure, a court order must be obtained so that the procedure may be performed without
patient consent in accordance with state law. According to Wisconsin law, guardians of patients lacking
decisional capacity may not consent to the performance of ECT without such a court order. Guardianship
and a court order are not required for non-decisional patients who are to receive ECT for purposes other
than mental health treatment (e.g., for treatment of seizures).
III. PROCEDURE

A. ECTs will generally be scheduled with the Ambulatory Procedure Center but may also be scheduled in other
clinical settings with the appropriate level of care to provide anesthesia and monitoring, e.g., operating room
or ICU level settings.
B. Prior to ECT, the patient’s medical record is reviewed to confirm a copy of the Patient Consent Form (or
court order in the case of patients lacking decisional capacity) is present. For patients who are receiving
ongoing maintenance ECT, the Electroconvulsive Therapy Consent form will be completed every twelve
months and placed in the medical record.
C. Surgical Services Departmental Policy 2.01-Admission of Patients to Surgical Services and Requirements
for Initiation of Surgical Procedures will be followed for ECTs done in the Ambulatory Procedure Center.
D. Post procedure, the patient will remain in the procedure room and continue to be monitored by anesthesia
staff until they meet the PACU phase of care discharge criteria.
E. Patients are taken to the APC prep/recovery area for phase 2 recovery. Patients will remain in this location
until they meet phase 2 discharge criteria. Once discharge criteria are met, sign out by anesthesia staff will
occur and the patient discharged to home or returned to their inpatient unit. Patients discharged to home
must be accompanied by a responsible person. See Surgical Services Departmental Policy 2.09-Discharge
of Surgical Outpatients Through Outpatient Surgery Center/First Day Surgery for detail.




UW HEALTH CLINICAL POLICY 2
Policy Title: Electroconvulsive Therapy (ECT)
Policy Number: 2.3.1

IV. FORMS

UWHC Electroconvulsive Therapy (E.C.T.) Consent Form

V. COORDINATION

Author(s): Nurse Manager, Inpatient Psychiatry
Senior Management Sponsor: SVP/Chief Nurse Executive
Reviewers: Director of Hospital Psychiatry Services; Hospital General Counsel
Approval committees: UW Health Clinical Policy Committee; Medical Board
UW Health Clinical Policy Committee Approval: May 15, 2017

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospitals and Clinics
and the University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs
administered by the University of Wisconsin School of Medicine and Public Health. Each entity is
responsible for enforcement of this policy in relation to the facilities and programs that it operates.

VI. APPROVAL

Peter Newcomer, MD
UW Health Chief Clinical Officer

J. Scott McMurray, MD
Chair, UW Health Clinical Policy Committee

VII. REVIEW DETAILS
Version: Revision
Last Full Review: October 8, 2015
Next Revision Due: October 2018
Formerly Known as: Hospital Administrative policy #10.24