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Joint Commission Issues Suicide Alert for ED, Med/Surg

Cheryl Clark, for HealthLeaders Media, November 18, 2010

The commission listed three key strategies to reduce risk of suicide among non-psychiatric patients.

1) Educate staff about suicide risk factors such as family history of suicide, anxiety and use of antidepressants, warning signs that may indicate imminent action, as well as changes in behaviors or routines.

2) Empower staff to call a mental health professional or resource person if a patient appears to be exhibiting behavioral changes.

3) Empower staff to take action, such as placing a patient under constant observation if the patient exhibits warning signs.

The events occurred in bathrooms, bedrooms, closets, showers, "or they occurred after discharge or leaving the hospital against medical advice," the commission's alert explains. Methods included hanging, asphyxiation by other than hanging, gunshot, jumping from a height, drug overdose, laceration, drowning and jumping in front of a moving vehicle.

Implements used to attempt suicide that aren't available in psychiatric units include bell cords, bandages, sheets, restraint belts, plastic bags, elastic tubing and oxygen tubing.

Some patients taken to a hospital because of illness or injury due to suicide attempts, such as a drug overdose, also may not disclose to staff that they caused their own reason for the hospital visit.

"General hospital patients who are suicidal attempt suicide after admission more rapidly and with fewer threats or warnings than suicide psychiatric inpatients," the joint commission's alert says.

Of the 827 suicide events in hospitals voluntarily reported to the commission since 1995:

  • 14.25% occurred in non-behavioral health units of general hospitals, such as medical or surgical units, intensive care units, oncology or telemetry.
  • 8.02% occurred in the emergency departments of general hospitals
  • 2.45% occurred in other non-psychiatric settings such as home care, critical access hospitals, long-term care hospitals and physical rehabilitation hospitals.

Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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