IDENTIFY PATIENTS AT RISK FOR SUICIDE

IDENTIFY PATIENTS AT RISK FOR SUICIDE NPSG # 15

Identifying Patients at Risk for 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 Performance • Risk Assessment • Address Safety Needs • Suicide prevention upon discharge

RISK ASSESSMENT

MEDICAL FLOORS • 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 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 SERVICES • 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)

Warning Signs of Suicide Patients • 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

Suicide Risk Indicators • 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 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 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 SERVICES • 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 PRECAUTIONS • 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

DOCUMENTATION • 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 SERVICES/MEDICAL FLOORS • Suicide prevention information (Crisis Hotline) is auto-populated on your discharge instructions

IDENTIFY PATIENTS AT RISK FOR SUICIDE