Preventing Suicides in the Hospital Setting


Many patients who commit suicide in the hospital have no history of suicide attempts -- but they do exhibit risk factors that physicians need to be aware of.

The Joint Commission has issued a Sentinel Event Alert to help improve suicide prevention in medical/surgical units and the emergency department (ED) by assuring that “patients outside of psychiatric units are appropriately screened and cared for.”

While psychiatric settings are designed to be safe for suicidal individuals and have staff with specialized training, typically, medical/surgical units and EDs are not designed or assessed for suicide risk and do not have staff with specialized training to deal with suicidal individuals, according to the Joint Commission. Not surprisingly, suicidal individuals often are admitted to general hospitals immediately following suicide attempts, or they seek help in hospital emergency departments when they are most desperate.

According to the Alert—which offers an update to previous guidelines issued in 1998—many patients who kill themselves in general hospital inpatient units do not have a psychiatric history or a history of suicide attempt. In the general setting, there is also more access to items that can be used to attempt suicide, and more opportunities for the patient to be alone to attempt or re-attempt suicide.

With that in mind, the Joint Commission is providing strategies that can be used and suggested actions that can be taken by general hospitals to help better prepare their staffs and their facilities for suicidal patients and to care for both their physical and mental needs.

Screening for suicide risk:

  • Watch for behaviors, mental status, or conditions that may indicate a risk of imminent suicide: acute signs of depression, anxiety, agitation, delirium and dementia; medical or psychological problems that significantly impact judgment, including intoxication with alcohol or drugs; orchronic pain or other debilitating problems, including chronic illness and terminal cancer
  • Screen patients who demonstrate these behaviors, mental status characteristics or conditions for suicide risk.
  • Provide for suicide screening in the emergency department.
  • As part of the hospital inpatient admission process, screen all patients for depression.
  • Use suicide screening and assessment tools that are appropriate for the person’s age and characteristics.
  • Provide a psychological consultation to assess immediate risk of individuals admitted for medical treatment following a suicide attempt.

Intervening to prevent suicide in those patients with increased risk of suicide:

  • Check the patient for contraband that could be used to commit suicide.
  • Provide person-centered care, which engages the person at risk in care planning and decision-making.
  • Tailor intervention strategies that take into account age or cultural factors.
  • Offer the patient the opportunity to be visited by a family member or volunteer who can offer peer support and alert staff to any warning signs that may indicate imminent action. Peer support can be provided by either a certified peer support specialist or someone who has had experiences similar to that of the patient, such as chronic pain, cancer, mental health problem
  • Engage the person at risk and his or her family in the care plan; the plan should include care after discharge.
  • During hand-off procedures (from practitioner to practitioner, shift to shift, unit to unit, and facility to facility or home), communicate changes in the individual’s condition or if the individual exhibited warning signs.
  • It is evident from the increasing number of reports that action must be taken to prevent suicide in the general hospital setting. It is vital, according to the Joint Commission, that health care professionals working in general hospitals review these strategies and determine which would be most effective in preventing suicide at their facility.

To read the Joint Commission Sentinel Alert in its entirety, click here.

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