The Royal College of Psychiatrists (2009) recommend that a senior psychiatrist, preferably a consultant, is responsible for the ECT clinic. For a standard clinical service, a minimum of one contracted session per week is recommended for the duties of an ECT consultant. The ECT consultant is responsible for making sure that the clinic keeps up to date with developments in ECT practice, achieves the necessary quality standards, and that all medical staff giving ECT are properly trained and supervised.
The duties of the psychiatrist responsible for ECT can be divided into four main areas:
organisation of the clinic
training and supervision; achieving competency
achieving and maintaining appropriate service standards.
This chapter outlines the role of the psychiatrist responsible for ECT and describes how medical staff achieve and demonstrate their competencies.
Organisation of the clinic
The location and fabric of the ECT clinic, including the ECT machine, should meet the standards set out in Chapter 2.
The clinic should be served by a small core team of senior anaesthetists, supported by appropriately trained personnel with a special interest in ECT and with whom discussion can take place regarding treatment protocols and responsibilities.
Nurse staffing should be as described in Chapter 11 and there should be good liaison with nurse management to ensure that these guidelines are being adhered to.
The ECT rota should be organised in such a way to ensure that continuity of patient care is maximised and that trainees have the opportunity to treat patients over several consecutive treatments. It is important that doctors training in psychiatry receive training in the practice of ECT, and the core curriculum states that ‘all Core training programmes must ensure that there is training and supervision in the use of ECT so that trainees become proficient in the prescribing, administration and monitoring of this treatment’ (Royal College of Psychiatrists, 2009). Electroconvulsive therapy consultants who have difficulty in maintaining the attendance of trainees are advised to consider whether this should be treated as an issue of professional practice/probity. These issues should be raised using the standard routes as set out in the Gold Guide (Modernising Medical Careers, 2010). This is likely to include discussion with the educational supervisor and training programme director in the first instance.