The Creation of a Policy for Suicide/Self-Harm Precautions

Suicide is a serious worldwide public health concern. It is the tenth leading cause of death in the United States, and an estimated 25 suicide attempts occur for every suicide death. It is estimated that 1,500 suicide deaths occur annually within hospital settings, and nearly one quarter of hospital suicide deaths take place in non-psychiatric settings. Health care providers within a large academic medical center in the Intermountain West can currently order either "Self-Harm" or "Suicide" precautions on inpatients in non-psychiatric areas. However, the hospital currently has no organizational standards regarding what these orders entail. The lack of common organizational language between providers and staff results in inconsistent interventions and creates the potential for significant patient harm. The hospital staff need a resource that outlines organizational expectations for the care of patients on these safety precautions and guides them through the specific steps necessary for implementing them. The purpose of this project was to develop a single hospital safety policy and accompanying clinical guidelines regarding the care of patients at risk for suicide and/or self-harm in non-psychiatric settings. The first objective of this project was the development of a policy outlining the process for implementing "Suicide/Self-Harm Precautions" on patients in non-psychiatric areas. The second objective was the development of a safety checklist for nursing staff utilizing evidence-based approaches for ensuring environmental safety for suicidal patients. The third objective was to present the policy and safety checklist to hospital administration and other stakeholders for consideration for organizational approval. The fourth objective was to present the project outcomes in a peer-reviewed forum such as a professional poster presentation. The first step for implementing this project was a review of current organizational practices for implementing either "Self-Harm" or "Suicide" precautions in non-psychiatric areas. The second step was a review of the existing literature on inpatient suicide statistics - particularly in non-psychiatric areas, suicide risk assessment, suicide prevention, and on policies addressing suicide safety. The third step was identification of key stakeholders and policy champions within the organization, including Quality and Patient Safety, Social Work, Psychiatry, Medical/Surgical Nursing, and Critical Care Nursing, and invite input into policy development. The fourth step consisted of drafting a policy and safety checklist and presenting it to stakeholder representatives for feedback and discussion, revising and reviewing the policy and safety checklist as indicated, and inviting further feedback and discussion. The fifth step was presenting a finalized draft of the policy and safety checklist to organizational administrative representatives for approval consideration. The sixth step was presenting the project to the state psychiatric APRN network for dissemination.