March 19, 2024
Written by
Alison McInnes, MD, MS
Are you thinking of seeing patients for IV ketamine? As a breakthrough treatment with approved off-label status by the FDA, proper documentation before, during, and after you see a patient is paramount.
The Ketamine Side Effect Tool (KSET) sets a gold standard in this domain with a comprehensive system for screening, baseline, acute treatment and follow-up assessments, using measurement-based care (Short et al., 2020). However, it’s hidden behind a paywall. For ongoing treatment documentation AFTER the initial intake, read this guide. The guide you’re reading now will provide you with the essential items you need to document prior to any ketamine administration.
Now, let’s go over each section in more detail.
Before initiating treatment, you should educate patients as to the importance of measurement-based care (MBC). MBC provides a clear patient baseline, fostering personalized treatment and liability protection. Ideally, send surveys before and after the standard initial course of treatment (the induction), which typically consists of 4-6 infusions administered within 28 days.
The Osmind EHR platform includes automated outcome surveys you can send to patients via a HIPAA-compliant app. These surveys, essential for documentation, measure treatment response.
Demographics are crucial for patient care. It goes without saying that you must be aware of your patient's racial and ethnic identity as well as pronoun preferences and gender identification. Level of education, employment status and relationship status are also very important factors that will affect outcomes.
Next, let’s look at medical history, psychiatric history, and medical history and possible contraindications for ketamine IV treatments.
The chief side-effect of ketamine, which is otherwise a very safe drug, is elevated blood pressure. This side-effect can sometimes be quite dramatic thus the clinician must screen for, any condition that could be exacerbated hypertension as listed here: (ketamine ROS)
Pay particular attention to conditions that might be aggravated by hypertension, such as uncontrolled hypertension, aneurysms, stroke, or other cardiovascular diseases.
Additionally, rare cases of hemorrhagic cystitis have been documented with chronic use of high dose ketamine, a condition flagged by the FDA to be on the increase. As we do not know for sure what dose, method of administration and cadence are absolutely safe, it’s crucial to be aware if your patient has a history of urinary tract infections. This is especially pertinent as psychiatric patients generally have a higher incidence of urinary tract issues.
Be sure to weigh your patient and calculate BMI. for BMI > than a certain threshold such as 36-40, clinicians might want to decrease the dose of ketamine for the initial infusion as increased incidents of extreme hemodynamic fluctuations and sedation complications may happen with obese patients when weight-based dosing is strictly adhered to.
Ensure the patient is using a reliable method of birth control to avoid pregnancy and explain that the risk of repeated ketamine usage to a fetus is unknown.
Please review all current and past psychiatric conditions. Inquire in general and specifically as follows:
Careful consideration should be given to the patient's current and past medication, noting any use of:
Pre-treatment lab tests include but are not limited to a test of thyroid function (TSH) and vitamin D levels. These labs are required to rule out reversible medical causes of depression. We encourage checking baseline liver function tests as there have been rare cases of elevated liver enzymes due to ketamine.
Baseline Vital Signs: Heart rate, blood pressure and pulse ox.
Clinicians should take a baseline urinalysis before starting ketamine therapy for several important reasons:
By conducting a baseline urinalysis, clinicians can ensure a safer and more effective treatment plan for patients undergoing ketamine therapy, addressing any potential risks proactively.
Outcomes must be measured to maximize patient benefit, help engage them in treatment and justify the cost to insurers. Regular assessment once response has been obtained will allow you to detect potential relapse should that occur.
The Osmind EHR platform includes 40+ scales you can send to patients via a HIPAA-compliant app. These surveys, essential for documentation, measure treatment response.
When it comes to mental health treatments, your clinic deserves a specialized Electronic Health Record (EHR) system. Osmind delivers precisely that—an EHR crafted with ketamine clinics' unique requirements in mind. Our system offers a harmonious blend of clinical precision and patient-centered tools, enabling you to concentrate on care while we manage the intricacies.
Osmind's unique Ketamine IV chart note streamlines your documentation process. Seamlessly capture all essential details, from infusion timings to patient vitals. Created in collaboration with top clinicians and grounded in evidence-based practices, we prioritize patient safety and compliance.
Watch Osmind's dedicated IV ketamine and SPRAVATO chart notes, with automatic REMS submissions in action:
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The Advantages of Osmind for Your Ketamine Clinic at a Glance:
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