Improving Quality and Compliance of Suicide Screening

Background:Suicide is one of the ten leading causes of death in the United States, with treatment costing the healthcare system over 70 billion dollars. It is essential to properly screen and identify patients most at risk. Additionally, the joint commission identified poor suicide screening or assessment as one of the top causes of suicide related sentinel event. Methods:Suicide protocol implementations were evaluated by identifying "overdose" and "suicide attempt" admits for quarter three (Q3) and quarter one (Q1) at a critical care pilot unit. Each patient identified had suicide screening compliance and protocol 1 implementations tracked based on suicide screen results. Pre- and post-education screenings were used to evaluate staff confidence, and retrospective/prospective were performed to evaluate implementation of screening compliance and protocol implementation. Interventions: Evaluation of retrospective data identified and used in education on current policies and procedures. All staff on pilot unit were identified and given pre-post-education surveys assessing confidence implementing protocols. Educational materials and instruction were provided to all staff. Patients were then selected following the same approach in Quarter one as Quarter three and evaluated for completeness of protocols. Results:The retrospective data identified 12 patients. Mean age of these patients was 48 (±21.9). Of the 12 patients; 9(75%) were screened for suicide, 8(66%) had positive suicide screens, 1(8.3%) was re-assessed each shift. Of those eight identified as at risk: 1(12.5%) had "suicide precautions" as an order, patient safety attendant (PSA) orders, restraint orders, dietary safety trays and social work consult orders and suicide specific discharge orders, 3 (37.5%) had PSA logs completed, 4 (50%) had crisis consult (Figure 2). Of the staff identified in the pilot unit 100% received education and participated in pre-education surveys, 76% participated in post-education surveys. Staff reported increased confidence in screening from pre (4.17 ± 1.0) to post survey (4.81 ± 0.40). There was a significant reported increase in confidence with implementing policy from pre (4.05 ±1.02) to post survey (4.78 ± 0.41) (p-value 0.001) (Figure 1). Prospective data identified eight patients. Mean age of patients was 25 (±9.0). Of these 8 patients; 7 (87.5%) were screened for suicide, 5 (62.5%) had positive suicide screens, 4 (50.0%) 2 were re-assessed each shift. Of those five identified as at risk: 2 (40.0%) had "suicide precautions" as an order, 4 (80.0%) had patient safety attendant (PSA) orders and dietary safety trays, 1 (20.0%) had restraint orders, 5 (100.0%) social work consult orders and suicide specific discharge orders, 6 (120.0%) patient identified had crisis consult (Figure 2). Of these categories, there was statistical significance (p<0.05) in the following:⦁Social work consult ordered (p=0.033)⦁Identified as suicide risk by telehealth (p=0.033)⦁Suicide specific discharge (p=0.033)Conclusion:Poor compliance with suicide screening and protocol implementation is most likely due to poor staff understanding of policy and procedures. Further education is necessary for significant improvements.