Shore Regional Health has been working to improve screening of patients for suicidal risk and taking steps to improve the safety of our environment and procedures. Suicide risk reduction is a Joint Commission National Patient Safety Goal and is an important patient safety initiative.
What We Do Now:
Any patient that presents with behavioral health concerns is screened for suicide risk. Any patient who screens positive for suicidal ideation is considered at risk for suicide. Patients who are at risk for suicide:.
- The patient is placed on 1:1 with continuous observation.
— 1:1 with continuous observation can immediately be initiated by a nurse.
— Continuation requires an order from a LIP/PA2.
- The patient’s room is checked for risk using a safe room check.
- For a Behavioral Health Admission, a Behavioral Health Evaluation consultation request is made and an evaluation is conducted by the Behavioral Health Response Team (BHRT). The BHRT team uses the Columbia Suicide Severity Risk Scale l to establish a stratified level of risk for the patient’s suicidality.
What has Shore Regional Health Done to Improve? During the past year SRH has taken a number of steps to improve safety and to reduce suicide risk, as follows:
- All of our facilities have been inspected by a multi-disciplinary team led by Senior Vice-President and Chief Nursing Officer Ruth Ann Jones.
- Key staff from Nursing, Behavioral Health, Patient Safety and Plant Operations attended an all-day UMMS symposium on suicide risk reduction to review the latest safety requirements and their implementation.
- Significant improvements have been made to our Behavioral Health unit that have included; new ligature resistant locks and door hardware, changes to patient bathrooms, and securing ceiling tiles in all community spaces to reduce ligature risk.
- Additional training on current suicide prevention procedures has been provided to patient care staff. A new high risk (suicide) management policy has been drafted and will be implemented with our EPIC Go Live in December.
How do we screen for suicide risk? In the past, just asking if the patient had suicidal thoughts was considered adequate for a suicide screening. Current best practice is to utilize an evidence based tool to evaluate the degree of risk posed by the patient for possible suicide. One of the most widely used, and endorsed by SAMSHA, is the Columbia Suicide Severity Rating Scale (C-SSRS). This is the evidence based tool currently in use by BHRT; it is being implemented at SRH and throughout all UMMS hospitals in December.
The Columbia uses six questions to stratify the risk posed by a patient into low, moderate, or high risk classifications. These questions are:
- Have you wished you were dead or wished to be dead or not alive anymore, or wish to fall asleep and not wake up?
- Have you had any actual thoughts of killing yourself?
- Have you been thinking about how you might do this?
- Have you had these thoughts and some intention of acting on them?
- Have you started to work out or worked out the details of how to kill yourself? Do you intend to carry this plan out?
- Have you ever done anything, started to do anything, or prepared to do anything to end your life? If yes, was this in the last 3 months?
- 1:1 with continuous observation means one staff member with eyes constantly on one patient.
- Patients on 1:1 with continuous observation are never out of staff sight and reach.
- A nurse can initiate 1:1 with continuous observation. An LIP/PA must write the order to continue or discontinue the intervention.
- Currently, prior to December 2, 2018, all patients screening positive for suicide ideation with current screening tools will be considered as high risk and will receive 1:1 with continuous observation. In December initial screenings will be conducted using the Columbia Suicide Severity Rating Scale.
- Share this information with your staff.
- If you or someone you know is dealing with suicidal thoughts, call 1-888-407-8018 to reach the crisis hotline.