The physician will reassess the patient according to suicide risk stratification using the Suicidality Impact Assessment - Management, Assessment and Care Planning (SIS-MAP Short Scanner). High risk for suicide: Score ≥ 9 on the Suicidality Impact Assessment Scale - Management, Assessment and Care Planning (SIS-MAP Short Scanner). Moderate risk for suicide: a score of 7 to 8 on the Suicidality Impact Assessment Scale - Management, Assessment and Care Planning (SIS-MAP Short Scanner).
Low suicide risk: A score of ≤ 6 on the Suicide Risk Assessment Scale for Impact of Suicide Management, Assessment and Care Planning (SIS-MAP Card Scanner).
Low Suicide Risk Interventions
Significant behavioral observations of patients and environmental issues are reviewed and reported promptly to the Charge Nurse. When patients are prepared for bed, the doors are left open at the discretion of the staff so as not to obstruct the patient's privacy. The worker must enter the room to observe the patient's condition, chest rising and respirations to ensure the patient is not in distress.
Flashlights may be used during night rounds, taking care not to flash the light in the patient's face, but so that staff can verify that the patient is in his/her bed and breathing normally. The Charge RN must review and sign the observation board at a minimum at the end of the shift to ensure completion as assigned.
Moderate Suicide Risk Interventions
Documentation of checks must occur during assigned patient rounds and not in advance. The staff member should closely observe the patient's condition and ensure that the chest is rising and breathing is regular and that the patient is not in distress.
High Suicide Risk Interventions
When patients shower, change clothes or use the bathroom, staff will remain with the patient. Staff will try to maintain patient privacy as much as possible; however, patient safety is the first concern. A member of the nursing staff will accompany the patient when medical treatment requires the patient to leave the unit (17) (18).
In cases of moderate suicide risk: it is indicated to refer the patient to a psychiatrist under supervision for complete evaluation and interventions and to limit access to lethal means. The form is completed by the physician and signed by both the physician and the patient, to emphasize the collaborative nature of the agreement. Staff should receive a minimum of 4 hours of education on national suicide management strategies specific to the patient population they serve by the National Task Force on Suicide Prevention and Management.
The patient's admission is necessary to manage his/her illness, to improve his/her condition or to stop its worsening. The patient must be admitted to maintain his safety and to provide the necessary treatment, and the reasons are explained to the patient's family according to the mandatory entry form number one. In the event of a complaint by the patient or his legal representative, this is done according to the psychiatric/treatment facility complaint/complaint form number four and the procedures set out in the Mental Health Care Executive Regulations. The system has been respected.
ZERO SUICIDE CONCEPT
SAFE ENVIRONMENT THROUGH PROPER SCREENING, ASSESSMENT, REASSESSMENT, CARE PLANNING, OBSERVATION &STFFING PLAN
Observation/Monitoring
There is a policy, procedure and checklist outlining staff roles and responsibilities when conducting patient observations. An observation plan is developed and communicated to all staff interacting with a patient regarding increased monitoring, etc. (Medical record notes, communication board). Before staff provide care or interact with a patient through enhanced observation, they review the observation plan.
Staff do not conduct 1:1 observation for more than four consecutive hours - ie. staff are being rotated out. And can be gradually improved until the staff does not carry out more than two consecutive hours of 1:1 observation. There is a procedure with steps to take to keep high-risk patients safe when they are moved from the unit or to a new area within a unit, ie a safety.
Nurses have the authority to initiate established behavioral criteria toward themselves or others based on restraint and/or seclusion before receiving orders from a psychiatric physician.
Plan of Care (POC)
Staffing Level, Training and Competency
THE ORGANIZATION-WIDE PHYSICAL ENVIRONMENTAL RISK ASSESSMENT
An organization-wide environmental risk assessment is used in psychiatric hospitals and psychiatric units in general hospitals to identify ligature points and objects that can be used for self-harm. The organization carries out quarterly environmental rounds in psychiatric hospitals and psychiatric units in general hospitals to identify ligature risks and ensure that any findings have been mitigated. For environmental assessments, the organization may obtain a second opinion (e.g. staff from other programs/services or external assistance) on environmental risks (13).
PHYSICAL ENVIRONMENTAL SAFETY RECOMMENDATIONS
- PATIENT ROOMS
- BATHROOMS
- EMERGENCY DEPARTMENTS
- SECLUSION ROOMS
- OTHER AREAS (HALLWAYS, COMMON AREAS, NURSING STATIONS….)
If televisions are present, they should be mounted high on the ceiling, screwed down and all power cords plugged into the ceiling so that they are not accessible to patients. For high-risk patients, consider placing the mattress on the floor without a bed frame, or a “captain bed” style frame. Door handles that can be used as an attachment point (e.g. door, cupboard door, bathroom, etc.).
Build safety features around plumbing fixtures, such as a stainless steel box that eliminates hang-up risk • Add "plates" to fixtures that allow functionality but reduce hang-up risk. If the patient is having suicidal thoughts, ensure that they are placed in a room immediately and not left in the waiting room. The patient should be undressed and the patient should be given clothes that do not have drawstrings and cannot be easily torn to pieces.
If televisions/screens are present, they should be high on the ceiling, bolted down and have any power cords in the ceiling and not accessible to patients. Patients at high risk for suicide should not be given plastic utensils for meals, give ordering choices that can be eaten without utensils (eg, consider using half-dome security mirrors at nursing stations to provide increased visualization (14).
SUICIDAL PRECAUTIONS & PATIENT’S ENVIRONMENTAL SAFETY FOR AT RISK PATIENTS
Is required for at-risk patients and the frequency of documentation will be determined by the level of risk. Nursing staff will use the Environmental Patient Safety Checklist and Behavior/Closing Observation Flowchart with the patient until the assessment is completed. A patient who is suspected of self-harm but is unconscious, comatose, or unresponsive due to his or her medical condition should be monitored regularly by the nurse for changes in level of consciousness.
As soon as the patient regains consciousness, the patient will be screened for suicidal risk and, if appropriate, assessed for level of risk and appropriate level of suicidal caution. Suicidal/suicidal behavior management and interventions - Recommended interventions based on level of risk as assessed. Special care should be taken while the patient is asleep or observation should continue while he is pretending.
All meals should be cut (bite size) to avoid choking and only plastic spoons, styrofoam plates and paper cups should be used. Stay with the patient while he/she is taking the prescribed medication to make sure he/she swallows the medication. The nursing staff will position the patient and use the behavior/close observation flow sheet to document the observation every 15 minutes.
PATIENT’S ENVIRONMENTAL SEARCH
Or any other object that in the patient's environment (eg bedding, curtain, gown, window/door rubber, etc.) poses a potential risk of injury to self or others. Stay with the patient while he/she is taking the prescribed medication to make sure he/she is swallowing the medication (check the mouth to check for medication). Send the patient's valuables home with the family or keep them in a secure locker with the patient.
Nursing staff will use the Nursing Environmental Suicidal Patient Safety Checklist every eight (8) hours to ensure that the patient at risk of suicide has been provided with a safe environment. Help the patient change into a hospital-supplied gown, gown and slippers with a nurse who is constantly present. Politely ask the patient to leave their room and stay in a designated area.
Provide seating for the patient outside the room during the search with a member of staff present at all times. Verify the list of items removed by the patient by obtaining his and a witness's signature. Allow the patient to return to their room when the room search is complete, with staff present as ordered.
PATIENTS’ BODY SEARCH & PATIENT’S ROOM SEARCH TO MAINTAIN A SAFE ENVIRONMENT
Ask the patient to remove their clothing, layer by layer from head to toe, search each layer, or ask a nurse to help the patient remove their clothing, and keep the clothing in a plastic bag. Run your hand through the patient's hair on the head and behind the ear. Ask the patient to remove any socks (slippers/sandals/shoes) into another labeled plastic bag, then check the patient's feet, especially the soles and the area between the toes.
If there is still a strong suspicion that the patient has prohibited substances on his body, help can be called and a full-body search can be conducted in a private area. Run your hands through the patient's hair, armpits, back and frontal parts of the body; thigh and legs. When the physical examination is complete, ask the patient to leave the room.
Any staff items such as money, cell phones and cigarettes, except chemicals, must be given to the Patient Affairs staff and kept in a safe and the patient property form must be completed and signed by both parties, the patient or his relatives who accompanied him and the patient. Affairs Personnel. Document the procedure and findings in the electronic patient record (HIS) nurses' progress notes. Any contraband found by the patient, an OVR should be initiated and forwarded to Patient's Affair for safekeeping or to condemn if necessary, inform the appropriate department to take action, e.g.
Improving risk assessment with suicidal patients: A preliminary evaluation of the clinical utility of the Suicidal Impact Scale–Management, Assessment, and Care Planning (SIS-MAP). Zero suicide is a key concept of the National Suicide Prevention Strategy 2012, a priority of the National Action Alliance.
