Suicide Prevention by Courtemanche & Associates


Suicide Prevention “ Ligature Risks and More  May 4, 2017

  • According to the National Alliance on Mental Illness (NAMI), 1 in 5 adults experience mental illness and over 20 million adults have a substance abuse disorder.  Behavioral Health issues in healthcare have been on the radar by The Joint Commission, since the formation of the first National Patient Safety Goal for behavioral health released in 2007. Patient Suicides account for over 10% of all reported Sentinel Events.  One of the highlighted points from the Sentinel Event Alert #56, released earlier this year, was that 21.4% of behavioral health settings and 5.14% of acute care settings were not in compliance with Safety Goal 15.01.01, EP1 in 2014.  This safety goal was focused on identifying specific patient characteristics and environmental features that may increase or decrease the risk for suicide.
  • By now, everyone should be aware of the renewed focus during surveys around preventing suicides and eliminating ligature points.  What better month than National Mental Health Month to take a moment to focus on Suicide Prevention in its entirety. Ensuring that your organization has completed a thorough and credible self-assessment is vital for Patient Safety.  Here are the steps:

    Step 1:  Identify areas (dedicated and non-dedicated) where psychiatric patients are cared for

    Step 2:  Conduct a robust environmental risk assessment. This is best accomplished by a multi-discipline team comprised of senior (C-suite) leadership, behavioral health team experts, facilities management, and local department staff.

    Step 3: Based upon your Risk Assessment, determine your mitigation strategies

    • Short term “ immediately reduce risk
    • Long term “ capital investment. Remember, for every long term strategy, you need to have a short term fix that will reduce the risk while waiting for implementation of the long term strategy.
      • Short term strategies might include: (1) Relocating the service to safer area (2)Providing additional staff (3) Increasing the monitoring of patients (4)Re-consideration of services provided

    Step 4:  Review processes & policies on patient screening, assessment/reassessment, placement of patients and resource allocation.

    Step 5:  Review staff education- have you offered programs to staff on providing care to patients with behavioral health issues, how to de-escalate and evolving situation and how to stay safe when de-escalation is ineffective.  Have you provided education on how to provide sitter services to patients with behavioral health needs?  The education content for behavioral health sitting maybe very different than risk for fall sitting services. Does the education include content around suicide risk awareness? Who have you educated?  Is the scope broad enough and include ancillary staff such as radiology, phlebotomy and respiratory staff?

    Step 6:  Assess competence of those staff assigned to provide care, treatment and services to patients with behavioral health needs.  Criteria could include their ability to assess the physical environment for risk.  Assure appropriate committee involvement.

    Step 7:  Document, document, document. Make certain your risk assessment is documented and up-to date.  Keep minutes of the team meetings, decisions and actions taken. Utilizing evidence based practices to assess and design your services is vital.  To assist you, here are several links: Some of the commonly referenced tools related to patient screening are as follows:  Patient Health Questionnaire (PHQ-9), ED-SAFE Patient Safety Screener, and for the Emergency Department, the Suicide Behaviors Questionnaire-Revised (SBQ-R).

    Use the most current edition of the Psychiatric Design Guidelines (2017) to assist you with identifying behavioral health approved products.

    Attached some tools (General) and Emergency Dept.)to help in the rounding process in addition to a risk assessment tool related to environmental issues

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