Stanford School of Medicine
Psychiatry and
Behavioral Sciences–

Comprehensive Inpatient Care at Stanford

The Inpatient Psychiatry Unit at Stanford University Medical Center offers in-depth evaluation and treatment of the broad range of psychiatric disorders with particular emphasis on Behavioral Medicine/Medical Psychiatry, Geropsychiatry and Affective Disorders. As part of a world-renowned university teaching hospital actively involved in on-going research, Stanford psychiatrists are prepared to treat the most challenging patients. We offer leading-edge consultation and therapies unavailable in many conventional psychiatric hospitals.

The Inpatient Psychiatry Unit at Stanford is recognized for its commitment to coordinating all patient care through a multidisciplinary team of healthcare professionals, including psychiatrists, psychologists, nurses, occupational and physical therapists, social workers and case managers. Both physicians and patients benefit from the full-range of resources at Stanford University Medical Center. Located on the second floor of the hospital, the 38-bed Inpatient Psychiatry Unit features both open ward (G2) and locked ward (H2) programs. Recently renovated, the unit is a modern, comfortable environment for both patients and families. It offers such on-site amenities as a kitchen, dining/activity area, a patio, and a solarium. The unit is also equipped with physical and occupational therapy rooms and an outside courtyard. Most importantly, our treatment program is structured to maintain the safety, dignity and confidentiality of every patient on the unit. We consider these the basic requirements for effective treatment to take place.

Click on a link below to view the various sections of this document:

Admission

Belongings
When patients first are admitted to the unit, staff will ask to examine any belongings brought with them, including items in their clothing. This is a routine procedure to prevent unsafe items from being carried onto the unit. Staff will be able to give advice on what items should be returned home or kept by staff until discharge. In general, bring only necessary items and do not keep valuables with you, as the hospital cannot take responsibility for belongings a patient chooses to keep on the unit themselves.

"Checks"
"Checks" is a routine part of life on the unit. Every half-an-hour or hour, 24 hours a day, a member of the nursing staff will check on the location and safety of each patient. Staff will knock on the doors of patient rooms, saying "checks" before entering. If patients are sleeping, staff still must enter the room to ensure that the patient is breathing comfortably.

Nursing Staff
Nursing staff work the following hours: morning shift, 6:45 AM to 3:15 PM; the evening shift, 2:45 PM to 11:15 PM; night shift, 10:45 PM to 7:15 AM. The morning and evening shifts are managed by a Resource Nurse who assigns individual nursing staff to work with particular patients during that time. Patients can find out which nursing staff member they will be working with by looking at the unit board located at the nursing station.

Interventions
All members of the treatment team work closely with patients to help them maintain control of any impulses to harm themselves, others or property. Sometimes, a patient's behavior may become out of control and the temporary use of seclusion or restraints is necessary. These interventions help reduce a patient's excessive agitation or fear by providing short-term mechanical control.

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Treatment Program

Our program offers specialized treatment of patients with affective (mood) disorders, as well as a wide range of other psychiatric diagnoses. The treatment philosophy introduces a combination of techniques tailored to the patient's individual needs.

Biological Treatments
Among the techniques are "biological" treatments, particularly the use of medications. Psychopharmacological treatment has proven to be very effective in the care of anxiety, panic, obsessive-compulsive and mood (depression and bipolar) disorders, as well as with psychotic illnesses. Electro-Convulsive Therapy (E.C.T) is also useful treatment for some types of mood disorders.

Psychotherapy
Another technique is "psychotherapy," or "talk therapy," during which the clinician gains insight into and understanding of the patient's problems and usual ways of dealing with them. The therapist helps the patient use this new understanding to manage problems more effectively in the future. In addition to individual therapy sessions, group sessions are also an important part of the patient's treatment plan. Some groups are based on psychotherapy techniques with a focus on how the patient is feeling "here and now." Some are more educationally oriented. Still others are focused on motor skills and activities, such as group outings or exercise classes. The treatment team will discuss with the patient which groups are best suited to his/her needs.

Milieu Therapy
A third approach is "milieu therapy," in which the patients and the staff on the unit are considered a whole community in themselves. Patients learn about themselves by participating in the life of the "unit" community, resolving its everyday problems and achieving its goals. The milieu provides structure, safety, mutual support and caring, and encourages active participation in an open flow of communication and feedback.

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Team of Caregivers

Each patient on the unit works with a multidisciplinary treatment team, comprised of a number of health professionals who work together to ensure that the treatment plan is comprehensive and accurately reflects each patient's needs. Members of the treatment team each have specific roles:

Unit Medical Director plans, directs and coordinates each patient's program on the unit. He leads treatment "rounds" and supervises the resident doctors.

Attending Psychiatrist meets with patients individually, consults regularly with other treatment team members and attends "rounds" to review the patient'sprogress. The attending psychiatrist may be a Stanford doctor or a doctor who has been seeing the patient outside the hospital

Resident Doctors provide attending care to those patients who are not being treated by their own outside attending physician.

Nurse Manager supervises the nursing staff in all aspects of their care for the patient and problem-solves to make sure that the unit milieu is as efficient, safe, and effective as possible.

Registered Nurses (RN) organize and implement a program of daily nursing care for each patient; collaborate with doctor's orders; dispense medications; assess the effectiveness of the care given to the patient and lead groups.

Other Nursing Staff: Licensed Vocational Nurses (LVN) and Licensed Psychiatric Technicians (LPT) take direction from RNs in providing direct care and supervision for patients. These licensed staff also dispense medications.

Unit Secretary coordinates patient appointments and medical records and maintains unit supplies. Support Service Assistants (SSA) provide housekeeping and escort services.

Social Worker helps the patient and family cope with the psychiatric illness and its impact on their lives; and ensures that optimal discharge planning and aftercare arrangements are made on behalf of each patient.

Occupational/Physical Therapist assesses each patient's emotional, vocational, educational, physical and recreational abilities; and implements a program to prepare the patient for life after discharge from the hospital.

Case Manager works with the patient, family and insurance carrier to provide the best services allowed under the policy coverage.

In addition to these unit staff, consultation may be provided by psychologists , pharmacists , and dietitians , as well as a wide range of other allied health staff. These consultations are part of the accurate assessment, diagnosis and treatment of the problems that precipitated a patient's hospitalization.

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Patient Privileges

Ward H2 is locked, therfore, staff must open the door each time a patient or visitor needs to enter or leave the unit. The ability of patients to leave the unit depends on the "privilege" level that they have been assigned. Privileges are determined by the treatment team, and are delineated as follows:

Level l: The patient is restricted to the unit. Most patients are at this level for a time following admission.

Level 2: The patient may leave the unit, if escorted by a staff member. Sometimes the patient must have a staff member escort him/her alone (2A); at other times a group of patients may be escorted by a staff member (2B).

Level 3: The patient may leave the unit alone to attend appointments or other approved activities on the grounds. They should telephone the unit (3-5001) to let staff know when they have arrived at their destination and when they are returning to the unit. When a patient leaves the unit, they are asked to complete a sign-out sheet at the nursing station. The sheet requires patients to indicate where they are going and when they expect to return, and later, when they actually do return to the unit.

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Unit Procedures

Visiting Hours
Regular visiting hours are 12:00 noon to 1:00 PM and 5:00 PM to 8:30 PM on weekdays and 12:00 noon to 8:30 PM on weekends and holidays. These hours were designed to ensure that visits do not conflict with the patient's treatment program. However, should these hours be particularly difficult for some visitors, the treatment team will make every effort to arrange other times. The social worker can help you with any problems regarding visiting times. Staff will ask that all visitors let them know of items being brought onto the unit. This policy is intended to prevent unsafe items from being unknowingly carried onto the unit (e.g., plastic bags are not allowed on the unit).

Meals
Individual meals are sent to the unit at breakfast (8:00 AM to 9:00 AM), lunch (12:00 noon to 1:00 PM) and dinner (6:00 PM to 7:00 PM). Snacks are available at other times. Patients are asked to fill out a dietary request card at the nursing station, indicating what meals they would like for the next day. If patients want meals brought from outside the hospital, they should let staff know. Patients are also asked to eat only in the dining room, and not to take food into their own rooms.

Medication Times
Medications are regularly dispensed at 9:00 AM, 1:00 PM, 5:00 PM and 9:00 PM each day. Nighttime medications may be given later. Patients are asked to be available to receive medications at the times they are due. Medications may be required between these regular times, on a "PRN" (as required) basis as ordered by the patient's doctor.

Telephone/Mail
The unit features two public telephones which are available for use by patients (numbers are: 415-853-9338; 415-725-9958). Calls should be limited to 10 minutes duration as a courtesy to other patients who may be waiting to use the phone. When a patient answers the phone, please say only "Hello, H2," to protect patient confidentiality. If the patient cannot take the call, then a message can be taken, but no information about the patient should be given out. Envelopes, stationery and stamps are available at the nursing station. (Patients are asked to pay for the stamps.) Mail is collected by the hospital delivery service for posting.

Property
As previously noted, patients may not keep items considered unsafe on the unit (see next section), and are advised not to keep valuable items in their own possession while on the unit. Patients are asked not to bring their own electrical equipment onto the unit unless this has been agreed upon by the treatment team. Cameras and tape recorders (if their purpose is to record conversations) are not allowed on the unit, to protect patient confidentiality. For long-term patient parking, contact hospital Security Services for a parking permit (723-7222). Patients should leave the keys with unit staff when the vehicle is not in use. Small amounts of cash may be kept for a patient in their property box at the nursing station. The hospital is not responsible for money that patients choose to keep themselves.

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Unit Regulations

Contraband
Alcohol and illicit drugs are never allowed on the unit. In addition, the following items may not be kept by patients on the unit:

These will be kept by staff at the time of admission and returned to the patient upon discharge. Razors and scissors are considered "sharps" and will be kept at the nursing station for patient use. Staff may need to supervise the use of sharp items by patients.

Smoking
Smoking is not allowed on the unit. Patients with off-ward privileges who wish to smoke must do so at designated areas off the unit. Staff on the day and evening shifts will accompany patients to the smoking area two to three times a shift. Smoking is not allowed on the night shift. Patients are encouraged to consider nicotine patches or gum as an alternative to smoking. A comprehensive smoking cessation program is available to patients who would like to use this hospitalization as an opportunity to stop smoking. Matches and lighters are not allowed on the unit. Lighters can be borrowed from the nursing station and returned after use.

Patient Rooms
Patients are asked to help keep their rooms clean and tidy. Clothing and other belongings should be stored in the closets and bureaus, not on the floor where people may trip over them. On a rotating basis, patients are asked to help keep the kitchen and dining facilities clean. Patients of the opposite sex visiting in a patient room should sit on different pieces of furniture and leave the door open.

Dress Code
Patients are expected to be dressed and ready to participate in the program by 8:00 AM on weekdays. Footwear and/or socks should always be worn on the unit, as walking in bare feet is a potential public health hazard. Staff may ask patients to change their clothing if it is considered inappropriate for the unit. To encourage good personal hygiene standards, laundry facilities are available on the unit. Patients are asked to attend to their personal hygiene outside of treatment program times.

Curfew
Patients may not leave the unit after 8:30 PM. Patients with a pass should return by 11:00 PM, unless otherwise arranged with the treatment team. Patients are also asked to be in bed by 11:00 PM, as good sleeping patterns are an important part of treatment. In order to support these bedtime hours, the TV will be turned off at 11:00 PM.

Patients' Rights
The State of California guarantees that all patients in psychiatric units will maintain certain basic rights. The "Handbook of Rights for Mental Health Patients" is given to all patients upon admission; the rights are also posted on the unit display board. These rights can be denied only if there is "good cause" to do so. This good cause is then reported to the county authorities. At Stanford, the Mental Health Advocacy Project of Santa Clara County serves as an independent patient advocate, ensuring that these rights are appropriately respected. The advocates are available to patients for consultation and advice at 1-800-248-6427.

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More Information

We hope that many of your questions have been answered and that this information helps orient you to the unit and its procedures. We would like all patients and visitors to feel as comfortable as possible on our units, as treatment is most effective in such an atmosphere. Therefore, if you have any other questions or concerns please do not hesitate to discuss them with an intake coordinator at 650-725-9848. The Patient Relations Hotline is 650-723-6000 (3-6000 in hospital). Thank you and we hope that your stay with us is a helpful and productive one.

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