Suicide Precaution Policy

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You are working on a newly opened observation unit in the hospital. Recently there has been an overflow of suicidal clients awaiting placement at the psychiatric facility. The staff recognizes there is not a fully developed policy on how to safely care for a suicidal client. Working together with case management and other staff nurses, you have been asked to create policy recommendations.

Your recommendations should include:

• How to create a safe environment

• Considerations or actions needed when a client is admitted or discharged

• Considerations or actions during the client’s admission
(length of stay)

• Identify allowable and restricted personal items for the client

• Expectations of client monitoring

• Describe the requirements of how the client is to be monitored, how often, and by whom.

Sample Solution

1. Creating a Safe Environment:

  • Physical Space:
    • Remove ligature points (belts, shoelaces, blinds, etc.) and hazardous materials (glass, razors, etc.).
    • Secure windows and doors.
    • Provide distraction materials (books, games, coloring books).
    • Maintain clean and comfortable space with adequate lighting.
  • Social Environment:
    • One-on-one observation by trained staff or volunteers.
    • Open and honest communication, encouraging clients to express their feelings.
    • Support groups and individual therapy sessions (as available).
    • Limit visitors to approved individuals who will not trigger the client.

2. Admission and Discharge Considerations:

  • Admission:
    • Complete comprehensive suicide risk assessment using standardized tools.
    • Document client’s plan, intent, and means of suicide.
    • Collaborate with case management for psychiatric placement within 24 hours.
    • Inform client of unit policies and safety procedures.
  • Discharge:
    • Ensure safe discharge plan with follow-up appointments and crisis hotline information.
    • Communicate discharge plan with client, family, and receiving facility.

3. During Client Stay:

  • Length of Stay:
    • Aim for minimal stay with continuous efforts towards psychiatric placement.
    • Monitor and reassess suicide risk regularly throughout the stay.
    • Avoid prolonged stays (ideally no longer than 24 hours) to prevent institutionalization.
  • Allowable Items:
    • Soft clothing and shoes without laces.
    • Toiletries in unbreakable containers.
    • Books, pens, and paper for writing.
    • Limited non-hazardous craft materials.
  • Restricted Items:
    • Belts, shoelaces, cords, ties, etc.
    • Glass, razors, metal objects, lighters, etc.
    • Drugs, alcohol, and cigarettes.
    • Sharp objects (pens, pencils, etc.) may require case-by-case assessment.

4. Client Monitoring:

  • Frequency:
    • Continuous (one-on-one) for high-risk clients.
    • Every 15 minutes for moderate-risk clients.
    • Every 30 minutes for low-risk clients.
  • Method:
    • Direct observation of behavior and verbalizations.
    • Open communication and active listening.
    • Monitoring room environment for potential hazards.
    • Documentation of observations and client interactions.
  • Staff Responsibility:
    • All staff should receive training in suicide risk assessment and intervention.
    • Assigned observers should be trained and experienced in de-escalation techniques.
    • Regular team communication and handover to ensure continuity of care.

Additional Considerations:

  • Cultural sensitivity: Respect individual differences and beliefs about suicide.
  • Collaboration with family and support systems: Involve family members when appropriate and with client consent.
  • Continuous policy review and update: Regularly evaluate and improve the policy based on best practices and experience.

Resources:

Remember, suicide prevention is a collaborative effort. This policy framework serves as a starting point, and ongoing staff training, communication, and adaptation are crucial in ensuring the safety and well-being of suicidal clients in the observation unit.

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