Replacing No-Suicide Contracts with Individualized Safety Assessments and Safety Plans in the Psychiatric Inpatient Setting

Background: Verbal or written no-suicide contracting is a common nursing practice in psychiatric inpatient settings, and remains common place in the Veterans Health Administration (VHA) inpatient psychiatric units. There is well supported evidence indicating that such contracts are oftentimes afforded clinical validity despite an absence of evidence attesting to their efficacy and validity as an effective tool in preventing suicides. More recent evidence supports the use of individualized safety plans and assessments as an effective alternative in working with suicidal patients. Methods: A quality improvement initiative was implemented that provided education to inpatient mental health providers regarding the current use of no-suicide contracts. Additional education was also provided regarding the efficacy of individualized safety plans and assessments as a more effective alternative in enhancing suicide prevention. Intervention: An educational intervention utilizing a Power Point presentation, was delivered to mental health care staff and providers to show evidence behind replacing no-suicide contracts with individualized safety plans and assessments. A comprehensive chart review was implemented to identify the current extent of utilization of no-suicide contracts, and a template was developed to replace no-suicide contracts in the Computerized Patient Record System (CPRS) at the VA upon institutional approval.