By Robin Diamond, MSN, JD, RN, Senior Vice President of Patient Safety and Risk Management, The Doctors Company

Suicide is now the 10th leading cause of death in the United States.¹ Most people who commit suicide received healthcare services in the year prior to death, usually for reasons other than mental health issues or suicidal thoughts. It’s a strong reminder that any patient can be at risk for suicide. A consistent and formal screening process, plus a response plan, will protect both the patient and the physician.

• Establish a formal policy on screening and responding to suicide risk. Establish a policy that stipulates what screening will be done and how to respond to suspected risk. All employees should be trained. The policy should include front desk staff and other non-clinicians, who may pick up on signs that the patient could be suicidal.
• Implement an effective screening process. Ask specific questions that can reveal situations that might put the patient at risk for depression and suicide. Examples include asking whether the patient has recently experienced the loss of a family member, a change in marital status, a change in jobs, sleeping difficulty, or loss of appetite.
• Connect with the patient. If in the screening process, the patient demonstrates suicidal tendencies or it’s suspected that the patient may be suicidal, refer the patient immediately to a mental health professional or ask the patient's permission to contact family members or outpatient treatment providers. Remember that simply advising the patient to seek help is insufficient. Be sure to follow up to confirm that the patient has seen the mental health professional.
• Establish safety procedures for the patient who may be suicidal. Once this risk is established, the clinician is responsible for protecting the patient from self-harm. That means keeping the patient away from sharp objects, medications, and bed sheets. Having the patient wait in a typical exam room may not be safe because the patient would have access to scissors, scalpels, needles, and other such items.
• Monitor the patient closely. If feasible, have staff or the patient's family monitor the patient continuously, in person or on video, until the next step of care. If continuous monitoring is not possible, check on the patient frequently. Carefully document the monitoring procedure, including frequency and type as well as observed patient behaviors.
• Call for help if needed. Call for additional help if the facility has no ability to isolate the patient from dangerous items or provide adequate monitoring, and also if the patient has already left against medical advice. State laws vary regarding how and when a patient may be held against their will.

Note: In addition to her legal experience, Robin Diamond has a master’s degree in psychiatric nursing from Vanderbilt University.

Reference

1. Detecting and treating suicide ideation in all settings. The Joint Commission. https://www.jointcommission.org/assets/1/18/SEA_56_Suicide.pdf. Accessed November 14, 2016.
      

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Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.