Hospital caregivers should step up their lookout for non-psychiatric patients who may be at risk for attempted suicide, especially in the emergency department and in medical/surgical units, the Joint Commission has announced in a Sentinel Alert.
More than 800 such suicides in hospitals have been reported to the commission since 1995.
"It is evident from the number of incidents reported that general hospitals must take action to prevent patient suicides. The mental as well as physical needs of patients must be addressed to prevent these tragic consequences," says commission president Mark R. Chassin, MD.
While psychiatric care settings have trained staff who know to look for suicidal behavior, staff in medical/surgical units and emergency department aren't necessarily evaluating the patient for psychiatric or suicide attempt risk.
"It is noteworthy that many patients who kill themselves in general hospital inpatient units do not have a psychiatric history or a history of suicide attempt. They are unknown at risk for suicide," the alert says.
"Compared to the psychiatric hospital and unit, the general hospital setting also presents more access to items that can be used to attempt suicide—items that are either already in or may be brought into the facility—and more opportunities for the patient to be alone to attempt or re-attempt suicide."
Suicide is one of the five serious events occurring in hospitals most often reported to the commission, and nearly 25% occurred in non-psychiatric settings, the commission reports.
Some risk factors for these non-psychiatric patients may include traumatic brain injury, dementia, chronic pain or intense acute pain, poor prognosis or terminal diagnosis and substance abuse.
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.