Suicide Precaution Policy
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.
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:
- American Foundation for Suicide Prevention: https://afsp.org/
- The Jed Foundation: https://jedfoundation.org/
- National Suicide Prevention Lifeline: 1-800-273-8255
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.