Table 4 Patient progress on the ward as documented in the electronic note system

1

Settled, anxious at times, joined in with activities.

Able to hold a conversation

Consented to ECT.

Quiet on arrival, but did answer 4/5 orientation questions correctly

Anxious, quiet, but pleasant on approach. Compliant with medications

Reported to be highly anxious, kept saying ‘no’ or ‘I don’t know’ – unable to give capacitous consent.

Moderate evidence of psychomotor retardation and evolving mutism. Did not appear to be responding to unseen external stimuli. She required full support for her personal care

2

Unable to consent

On return to the ward, she refused medications, spitted them out and had her mouth closed

Poor oral and fluid intake, received IV fluid treatment due to dehydration and deteriorating renal function

3

4

Very anxious and unable to answer any of the orientation questions

Able to drink full cup of squash and ate 2 biscuits. Completed 4/5 orientation questions

Upon returning to the ward, she became very anxious and hardly communicative. She was visibly shaking and humming

5

Very anxious and unable to answer any of the orientation questions

Intermittent compliance with prescribed oral medication

6

Remained anxious and reluctant. Unable to answer any questions

Had half a beaker of squash and IV Hartmann’s. Unable to obtain MMSE

Minimally interactive, and will respond with single words (no, no, no)

7

Had to be brought on a trolley due to high level of anxiety, distress and agitation

Had some tea and biscuits – couldn’t answer orientation questions afterwards

She was having minimal conversation and continued to say ‘no, no, no.’

8

Very anxious and was reluctant. Unable to answer any of the orientation questions

Had a mug of tea 280mls as well as 500 ml of Hartmann’s Fluid IV

She has been keeping tablets in her mouth at times.

Staff had to escort her to the toilet using a wheelchair

9

After the session, had tea, toast and biscuit. Conversed with staff about dieting, exercise and dogs

She returned to the ward with a smile. Then in the afternoon, she returned to the anxious state. She did manage all her meal

10

She had been variable in presentation. When she is less anxious, she could feed herself. Other times, she refused to eat and drink

She had been sat in the communal area post-ECT.

She was reasonably settled but gradually got anxious and had been repetitive and making sounds

11

SOAD applied for 6 further ECT sessions

She was very calm, however did not interact with staff other than with short answers. She accepted a mug of tea and one and half slices of toast and marmalade. She was unable to answer any of the orientation questions

She has been out in the garden for a walk. She joined in the colouring group and participated well. Accepted medication with less prompting

12

After the treatment, she was much calmer, however appeared confused at times. She had tea, cheddars and toast

She engaged well in physiotherapy strength and balance sessions

13

Calm. Did not answer any of the orientation questions. The only thing she said was ‘what is my name.’ She walked calmly back to the ward with staff

Eating and drinking well. Taking food in the canteen now, despite eating slowly. Minimal assistance required with personal care

14

Accepted tea and toast. She was able to answer 2/5 of the orientation questions, however did say ‘my name used to be …’

She had been settled and calm, spent time in communal area with others. She engaged well when spoken to and has not been making any noise.

15

She was able to tell us her name, date of birth, however followed each answer by ‘well it used to be’

When staff talked to her, she would always respond back with talking to staff. At times, she did smile to staff

16

She was able to walk to the clinic with a member of staff and answered 3/5 of the orientation questions. She became increasingly anxious when being prepared for ECT, however remained cooperative throughout

She was able to tell us her name and date of birth, but responded ‘I have no idea’ when asked where she currently is

Walked back to the ward with no concerns

17

She was able to answer 3/5 of the orientation questions

She had cheddars and tea after the treatment. She completed 4/5 orientation questions and initiated the conversation briefly

She joined drama therapy group for the first time. Although she appeared quiet throughout the session, she contributed vocally and artistically to group exercises

18

ECT cancelled due to temperature of 37.7 °C

She was bright in mood, smiling more, playing dominoes with other service users. Eating and drinking well. She could reflect on how severely unwell she was