artifact: edu rulebook, unabridged

artifact
e.d.u. rulebook

Samuel Tuke Center
Eating Disorder Unit
Rules and Therapeutic Expectations

Treatment Stages

Stage One: The dual focuses of stage one are (1) medical safety of patient (2) patient acceptance that he/she has an eating disorder requiring treatment. Stage one includes:

Regular monitoring of vital signs and medical concerns
No unsupervised showers or baths until medically cleared by physician
No off-campus trips, passes, or excursions unless approved by physician
One-to-one staff-to-patient ratio, with ten minute checks. At staff discretion, a stage one patient may be allowed in bedroom without staff; staff will check on patient at a minimum of once every ten minutes during waking hours.

Stage Two: patient may request and start earning privileges as approved by treatment planning team. Stage two privileges can include:

Off-campus meetings and activities supervised by staff
Up to three off-campuses passes per week, totaling ten hours per week, with approved chaperone or accompaniment. (Chaperone MUST be patient’s legal guardian if patient is under 18). Destination must be pre-approved.
Morning walks (7 a.m.) at indoor track, Syracuse University (outdoor if weather permitting). Patients with morning walk privileges must drink one 8 oz. juice in addition to meal plan exchanges, before leaving for walks, and must remain in staff view at all times.
Supervised “shop walk” to stores downtown when offered by staff
Art room access with supervision
Outdoor smoking courtyard access

Stage Three: Patients underweight at time of admission must reach maintenance weight to be considered for most stage three privileges. Stage three privileges include:

7 a.m. walks, jog-walks, or jogs as approved by treatment team (8 oz. juice and eyes-on supervision, as above)
Breakfast in downstairs dining room
Lunch in downstairs dining room
Regular trays
Unsupervised bathrooms
Meal planning
One weekend day pass with lunch out, with approved accompaniment or chaperone
Snack-out with staff
Meal-out with staff
Knowledge of weight
Discharge date
Discharge plan

Treatment Planning

Treatment planning meetings occur once a week for each patient (Monday, Wednesday, or Friday).
A patient’s treatment planning team shall consist of nursing staff (including patient’s primary and/or secondary nurse), director of EDU, patient’s psychiatrist, a nutrition team member, and relevant social worker/s and therapists (if applicable).
Each patient shall be made aware of her treatment planning schedule within the first week of admission.
Patients must request passes or privileges IN WRITING TO THEIR PRIMARY OR SECONDARY NURSE, before 8:00 a.m. on the morning of their assigned treatment planning day. It is the patient’s responsibility to submit requests on time. Late requests for privileges will not be accepted for any reason.
Each patient shall be assigned a primary and a secondary nurse, who will inform the patient of treatment planning goals, as determined by the treatment planning team.

Meals and Food

Newly admitted patients shall begin meal plan of 1200 calories per day for first week (seven days) following admission.
If weight gain is required, caloric intake shall increase weekly: 1200, 1800, 2500, 3000 until patient reaches maintenance weight.
If necessary, additional calories and supplements will be given to patients on 3000 calorie meal plan.
If weight gain is not required, patient will continue at 1800 calorie plan, or other necessary for weight stabilization, as determined by treatment team.
If weight loss is necessary, patient will continue at 1200 calorie meal plan.
All meal plans are subject to change without patient notice as is deemed necessary by treatment team.

Patients are REQUIRED TO EAT ALL FOOD EXCHANGES AS SERVED, with the exception of dislikes as enumerated below.

Patients shall not be late for meals.

Breakfast is served at 8:00 a.m.
Lunch is served at 12:00 p.m.
Dinner is served at 5:00 p.m.
Snack is served at approximately 8:30 p.m.

Breakfast, lunch, and dinner shall be eaten while seated at dining tables in the lounge (except for stage three patients with breakfast and lunch dining room privileges).

Patients must finish eating all food on tray within one hour from time meal is served.

Patients must remain seated at table for thirty minutes after finishing meal.

Patients must remain in the EDU lounge for an additional thirty minutes, totaling one hour of after-meal supervision.

Patients may not use bathroom for one full hour after meal is finished.

Patients may select up to two condiments per meal from the condiment tray.

Patients who are served salad dressing may make a 1:1 trade for a different flavor salad dressing from the condiment tray.

Garnishes and gristle do not have to be eaten. In the event of disagreement as to what constitutes “garnish” or “gristle,” staff retains sole determination. Staff directives must be followed.

Garnish examples: parsley sprig served with chicken, lemon wedge served with fish
Garnishes are NOT: skin on chicken or turkey. This is not a garnish and must be eaten.
Gristle examples: a distinct section of fat on the edge of meat
Gristle is NOT: small lines of fat within meat. This is part of the meat and must be eaten.

Snack may be eaten anywhere in the lounge.

Snack must be finished within 30 minutes of serving, and patient must remain in lounge for 30 minutes after finishing snack.

DISLIKES: Each patient is allowed three “dislikes,” for which they may substitute a 1:1 exchange. Staff will provide patient with appropriate exchange.

Dislikes must be specific. I.e., “red meat” cannot be a dislike. Patient must choose “veal” or “roast beef,” or “hamburger patty.”
Dislikes must be eaten once (or more) before they can be listed.
Once a dislike is declared, it can not be changed for any reason.

OPTIONALS: Patients are allowed, but are not required, to consume up to two “optional” liquids per day between meals. Optionals are subject to staff discretion.

Choices include: 8 oz. apple, cranberry, or orange juice; one cup herbal tea; one packet Sanka decaffeinated instant coffee; one packet instant hot chocolate; or one 12 oz. non-caffeinated, regular soda from the soda machine.
Patients are responsible for paying for soda from the vending machine.
No caffeinated drinks, artificial sweeteners, or diet beverages are allowed at any time.
Patients may drink water, but should avoid tanking or binge behavior.

Therapy and Therapeutic Activities

Patients are expected to participate in all groups and therapeutic activities as directed by staff.

Patients shall comply with psychological and physical testing as directed by treatment team.

Patients shall comply with medical and therapeutic guidelines, including taking of prescribed medication.

Patients will write a Personal Eating Disorder History and read it aloud to EDU patients and staff when assigned by treatment team.

All EDU patients shall attend:

EDU group therapy (daily Monday-Friday, 10:00 a.m., lounge)
family therapy (time and location TBD, with assigned social worker)
individual therapy with director of EDU (weekly, office of director, time TBD)
individual therapy with assigned psychiatrist (weekly, office of psychiatrist, time TBD)
Overeater’s Anonymous when held in-house (weekly or twice weekly, lounge, time TBD)
EDU community meeting (weekly, lounge, time TBD)
Assertive Training (weekly, Monday 7:00 p.m., large 2nd floor lounge)
Wellness and Nutrition (weekly, Monday 1:30 p.m., activities room 1)
Meditation (weekly, Tuesday 1:30 p.m., activities room 1)
Journaling (weekly Wednesday 1:30 p.m., activities room 1)
Art therapy (weekly, Thursday, 1:30 p.m., activities room 1)
Body Image Workshop (twice monthly, large 2nd floor lounge, time TBD)
Sexual Assault & Abuse Surviver’s Group, Alcoholics Anonymous, Narcotics Anonymous, Chemical Dependency Education, Al-Anon, Depression Workshop, etc. as prescribed by treatment team (various times, locations)
Arts and Crafts (if not in prescribed therapy group, Tuesdays and Thursdays 11:00 a.m., activity room 2)

In addition, all medically cleared patients will attend:

Off-campus Overeater’s Anonymous and/or National Association of Anorexia Nervosa and Associated Disorders (ANAD) groups (TBD)
Movement Therapy (1:30 p.m., alternating Fridays, movement studio)
Aerobics (1:30 p.m., Fridays alternating with Movement Therapy, movement studio)

Toilets and Bathing

All bathrooms on the EDU, including those in patient rooms, shall remain locked at all times, except for the hours of 6:00 to 8:00 a.m.
All patients may close the bathroom door and flush their own toilets between the hours of 3:00 and 8:00 a.m.
When a patient is using bathroom, door must remain open at least five inches (except between the hours of 3:00 and 8:00 a.m., and patients with bathroom privileges).
Patients must not flush toilets. Staff must check and flush toilets (except 3:00 and 8:00 a.m., and patients with bathroom privileges).
Patients may only use toilets on the EDU. Patients are not to use toilets in any other area of hospital.
Patients needing to use the bathroom during off-campus meetings and excursions must be supervised by staff.
Patients must be medically cleared before they can take a standing shower.
On request, staff will provide supervision of tub bath and/or hair washing for patients not yet medically cleared.
Patients are expected to maintain good hygiene, as determined by staff.

Additional Privileges and Responsibilities

VISITORS

Patients may not receive visitors for one full week (seven days) after admission. For instance if admission occurs on Wednesday at noon (12:00 p.m.), patient may not receive visitors until after noon (12:00 p.m.) the following Wednesday.
Visitors must be approved by staff, prior to visitation.
Visitors must sign in and out at front desk, be accompanied to unit, and wear visible visitor badge at all times.
Visiting hours are from 6:00 p.m. to 9:00 p.m. weekdays, and 8:00 a.m. to 9:00 p.m. weekends and holidays, NOT INCLUDING SCHEDULED GROUP, ACTIVITY, AND/OR MEAL TIMES.
No visitors may be received during meal times. (“Meal times” in this case begins when meal is served, lasting until 30 minutes after patient wishing to receive visitors has finished tray).

PHONE

Patients may not use the phone to make or receive calls for the first 48 hours after admission.
48 hours after admission, patients may use the pay phone in the EDU lounge.
Use of any other phone is prohibited, including other pay phones or office phones, or during off-campus excursions and passes.
Phone may only be used during patient free time.
Phone may NOT be used during meal or snack time.
Phone may NOT be used between the hours of 11 p.m. - 7 a.m. weekdays and 12:00 a.m. - 7 a.m. weekends.
Patients are responsible for payment of phone calls.
Portable telephones (such as “DynaTAC” or “Talkman”), or other so-called “bag,” “cellular,” or “wireless” phones, are not permitted.

TELEVISION

Television and VCR in EDU lounge can be watched during patient free time.
Television must remain off during meals and for one full hour after the last patient has finished eating.
Television must remain off during snack, but may be turned on when last patient has finished eating snack.
Television must be turned off at 11 p.m. weeknights (Sunday through Thursday) and after 12:00 a.m. (midnight) on weekends.

SMOKING

Smoking is permitted in the EDU lounge and in therapy and group rooms where approved by staff
Patients in stage two and three may also smoke in outdoor smoking courtyard and off-campus
Staff must be present when a patient is smoking.
Smoking is not permitted during meals until after patient is finished eating and tray has been checked.
Smoking is not permitted in patient bedrooms.
Patients under the age of 18 are not permitted to smoke except with signed parental/guardian consent.
Staff must light cigarettes.
Patients are forbidden to possess lighters, matches, or ignitable devices of any kind.

BEDROOMS

Patients must use masking tape (not transparent “Scotch” tape) if attaching posters or pictures to bedroom walls.
Decorations must be paper/cardboard only.
No decorations may hang from the ceiling.
Decorations made of string or twine, such as macramé wall hangings, are not allowed.
Decorations must be tasteful and are subject to staff approval.
Patients shall keep their rooms neat.
Patient bedrooms are subject to staff search at any time without notice.
Bedroom doors must remain at least five inches open at all times.
Bedroom window screens and locks shall not be tampered with.

BED TIMES

Patients under 18 must be in bed by 10:30 p.m., with lights out by 11:00 p.m., weeknights (Sunday through Thursday), except holidays.
Patients 18 and over must be in bed by 11:45 p.m., with lights out at 12:00 a.m. (midnight) weeknights.
All patients must be in bed by 12:45 a.m., lights out at 1:00 a.m. weekends and holidays.

OTHER

EDU patients may not fraternize with patients from other units, with the sole exception of staff-supervised groups or activities (such as Assertiveness Training, AA/NA groups, Movie Night, etc).
Patients will not engage in unsupervised physical exercise at any time.
Patients under 18 who are in school must meet with assigned tutors from 3:00 p.m. to 5:00 p.m. weekdays and complete all school work.
Patients must remain on EDU unless accompanied by staff. (Exception: patients in stage three with dining room privileges.)
All sharps and contraband MUST be declared and surrendered to staff.
Patients must submit their shopping bags, purses, knapsacks, backpacks, etc to staff for search after all off-campus activities or passes.
MEDICATION OF ANY KIND, INCLUDING ANY AND ALL PRESCRIPTIONS AND OVER-THE-COUNTER MEDICATION, MUST BE SURRENDERED TO STAFF. With the exception of tylenol for menstrual cramps, which can be provided by nursing staff, all medication must be approved by patient’s psychiatrist. Staff will dispense medication at appropriate times.
Patients are not to drink alcohol or use any other mood-altering substances at any time, whether on or off campus.
Patients are not to weigh themselves at any time, whether on or off campus.
Mail, including envelopes and packages, are subject to search.
Patients may use washing machines and dryers in vending room with staff supervision. Patients must pay for laundry machines.
Patients may not wear sweatpants, sweatsuits, or other “weight loss” clothing.