Referral Criteria: Clients must be enrolled in Providence Care’s Mood Disorder Service to be eligible for the IV ketamine treatment.
Type of Service: Ketamine is a fast-acting anesthetic that’s being used to treat people with depression who have not responded to other treatments. The ketamine is given in a very low dose through an intra-venous (IV) line. Ketamine has been around for decades but is now being used for adults with treatment resistant depression.
Forms
South Eastern Ontario Addictions & Mental Health Service Access Form (LHIN mandated form)
Low Dose Ketamine Infusion Order Set (500098)
Low Dose Ketamine Infusion Screening Assessment (500184)
Esketamine Pre-Administration Checklist (500190)
Esketamine Order Set (500194)
Pre-Esketamine Screening Assessment (500195)
Low Dose Ketamine Therapy Checklist (500110)
Ketamine Administration Record (500196)
