IDENTIFY PATIENTS AT RISK FOR

SUICIDE

NPSG # 15

IDENTIFYING PATIENTS AT RISK IDENTIFYING PATIENTS AT RISK FOR SUICIDEFOR SUICIDE

Why is this important?

• Suicide of a patient while in a hospital setting is a frequently reported sentinel event

• Identification of individual at risk for suicide while under the care of or following discharge from a hospital is an important step in protecting at risk individuals

ELEMENTS OF PERFORMANCEELEMENTS OF PERFORMANCE1. Risk Assessment

2. Address Safety Needs

3. Suicide prevention upon discharge

RISK ASSESSMENT

MEDICAL MEDICAL FLOORSFLOORS

RISK ASSESSMENT SAD PERSONS Suicide Risk Assessment

completed upon admission and as indicated based on clinical assessment

SCORED TO DETERMINE RISK AND INTERVENTION 1-2 Low 3-6 Moderate (communicate to MD) 7-10 High (notify MD for additional orders)

EMERGENCY DEPARTMENTEMERGENCY DEPARTMENT

RISK ASSESSMENT• ED Suicide Screening Tool

the patient will be triaged by the RN

• Scored to determine risk and intervention 1-2 Low Risk (monitor patient) 3-6 Moderate (communicate to MD) 7-10 High (notify MD & charge nurse)

BEHAVIORAL HEALTH BEHAVIORAL HEALTH SERVICESSERVICES

RISK ASSESSMENT Suicide/Self Harm Assessment

completed upon admission and as indicated based on clinical assessment

SCORED TO DETERMINE RISK AND INTERVENTION 0-12 Low (q15 minutes) 12-16 Moderate (L.O.S, notify MD) 16-20 High (1:1, notify MD)

Talking or writing about death, dying or suicide

Threatening to hurt or kill self Hopelessness Increasing alcohol or drug abuse Withdrawing from friends, family or society No reason for living, no sense of purpose in

life

A previous suicide attempt Extreme mood swings; very depressed

followed by happy episodes Drastic changes in habits, friends, or

appearance Giving away prize possessions

ADDRESSING SAFETY NEEDS

MEDICAL FLOORSMEDICAL FLOORS

Patients considered at risk for suicide will receive continuous 24-hr observation

Belongings/valuables placed in plastic bag Dietary department to use paper/plastic goods Observation maintained until attending MD

discontinues order

EMERGENCY DEPARTMENTEMERGENCY DEPARTMENT

Patients considered at risk for suicide will receive continuous 24-hr observation

BHS notified to complete intake assessment• Ultimate goal is to detain patient until the 5150

determination or patient is no longer a risk Patient will wear paper gown Belongings/valuables placed in plastic bag for

safe keeping Dietary department to use paper/plastic goods Family members or significant others not

allowed to visit while on 5150 or 5250

BEHAVIORAL HEALTH BEHAVIORAL HEALTH SERVICESSERVICES• Patients considered at risk for suicide will receive continuous

24-hr observation.• MD order for LOS or 1:1

Must be renewed every 24hrs Educate patient regarding observation

• LOS (Line-of-Sight) Patient is able to contract for safety Maintain visibility at all times Staff cannot have additional assignments

• 1:1 Patient cannot contract for safety Maintain visibility One arm length from patient at all times Document on patient every 2 hours Staff cannot have additional assignments

GENERAL SUICIDE GENERAL SUICIDE PRECAUTIONSPRECAUTIONS

• Patients considered at risk for suicide will receive continuous 24-hr observation Family members or significant others cannot be used

as sitters Must have continuous unobstructed view of the

patient, including during toileting The observer is not to have reading material, accept

phone calls, or talk with other staff members Maintain safe environment and free of hazards

Medical floors/ED: be aware of telephone cords, curtain controls, shoe laces, pajama strings, IV tubings, plastic bags, wire hangers, and belts

DOCUMENTATIONDOCUMENTATION

• Document thoroughly the need for suicide precautions

precipitating event interventions used patient response to interventions efforts to maintain safe environment

SUICIDE PREVENTION UPON DISCHARGE

BEHAVIORAL HEALTH BEHAVIORAL HEALTH SERVICES/SERVICES/MEDICAL FLOORSMEDICAL FLOORS

• Suicide prevention information (Crisis Hotline) is auto-populated on your discharge instructions