National Patient Safety Goal 15.01.01

Identify individuals at risk for suicide.

Julie-ann Forrester

Nursing Quality

Summary of National Patient Safety Goal “NPSG” 15.01.01 and

Scope and Severity

• NPSG Goal 15.01.01 is for health care professionals to identify individuals at risk for suicide.

• This presentation will focus on the Emergency Department “ED”.

• This is where most patients enter a hospital.• The ED staff may be the only healthcare providers

patients see if they are discharged.

Scope and Severity Continued

• The number of ED visits for attempted suicide has more than doubled in the last decade.

• Up to 25% of suicide attempters seen in the ED end up making another suicide attempt.

• Interventions must be initiated promptly after the ED because most suicide reattempts happen within 3 months of discharge.

Quality Improvement Initiatives for NPSG 15.01.01

In order to meet NPSG 15.01.01 the nurse must:

Goal 1) Conduct a risk for suicide assessment.

Goal 2) Address the immediate safety needs of the individual.

Goal 3) Provide suicide prevention information at discharge.

Initiatives to meet NPSG 15.01.01

• The SAFE VET program to meet all three goals.

• Specialized education in mental health nursing to meet goal 1.

• Universal screening program and wraparound safety system to meet goals 1 and 2.

• Telephone follow-up/postcards to patients to meet goal 3.

How the Initiatives meet IOM Aims• To meet the IOM’s six aims these initiatives provide:

• Safe Care: Prevent patient’s at risk for suicide from injuring themselves.

• Effective Care: Provide services to patients identified as a suicide risk and focus interventions on these patients.

• Patient/Family-centered Care: Provide respectful and responsive care and involve the family by informing them of objects they should not bring to the hospital

• Timely Care: Prevent harmful delays by identifying those at risk for suicide. Also follow-up phone calls are provided within one month of discharge.

• Efficient Care: Postcards can be sent quickly without creating waste.

• Equal Care: Unbiased care that does not discriminate.

http://hospitals4health.files.wordpress.com/2011/09/frame-work-succes-graphic4.gif?w=1024&h=326

Initiative 1: Suicide Prevention in Veterans in the Emergency Department: SAFE VET

• A project at the Department of Veterans Affairs has been successful in preventing suicide.

• This project involved:• Identifying those who are moderate to high suicide

risk• Providing them with impatient mental health services• Referring them to intensive outpatient follow-up care

• 93% of Veterans studied agreed to use the SAFE VET intervention.

Initiative 2: “Caring for patients with suicidal behaviour: an exploratory study”

• Study in Ireland at a large hospital ED department• The study determined that because of lack of psychiatric

services, ED staff lacked skills on how to communicate with suicidal patients.

• This can hinder the ability of the nurses to do a thorough risk assessment.

• The study results show that nurses need specialized education in mental health nursing.

Initiative 3: Universal Screening Program and Wraparound Safety System

• In order to address the immediate safety goals of the patient (goal 2) hospitals should implement a universal screening.

• This program should include a wraparound safety system in which the patient is never left alone

• It should also include education to the family about items that the patient could use to harm themselves.

• Finally, certain patients should be labeled high suicide risk.

Initiative 4: Effect of Telephone Contact on Further Suicide Attempts

• According to the study “People who have attempted suicide are at high risk of further attempts or completing suicide within a year.” (Vaiva & Meyer, 2007).

• People who attempted suicide were contacted by telephone one month and three months after discharge from the ED.

• Telephone contact enabled the detection of people at high risk for future suicide attempts.

• Patients at risk for suicide who are seen in the ED should be referred for telephone follow-up (meeting the third goal of NPSG 15).

Initiative 5: Postcards from the Edge

• In order to meet goal 3, patients who present to the ED with attempted suicide should receive follow-up care that includes postcards.

• A study in which postcards were sent to patients at 1, 2, 3, 4, 6, 8, 10 and 12 months showed a decreased rate of repeated hospitalization.

• Postcards are easy to send and low-cost.

Initiative 5: Postcards from the Edge: Postcard Example

Conclusion

• In order to meet National Patient Safety Goal 15.01.01 ED nurses should:• Utilize the SAFE VET program as a guide;• Undergo mental health training;• Provide universal screening;• Use a wraparound safety system so the patient is

never left alone; and• Refer patients to telephone follow-up or send

postcards to patients.

References• Carter, G., Clover, K., Whyte, I., Dawson, A., & D'Este, C. (2007). Postcards from the

EDge project: randomised controlled trial of an intervention using postcards to reduce repetition of hospital treated deliberate self poisoning. BMJ: British Medical Journal (International Edition), 331(7520), 805-807. doi:10.1136/bmj.38579.455266.E0

• Crossing the quality chasm : a new health system for the 21st century / Committee on Quality Health Care in America, Institute of Medicine. (2001). Washington, D.C. : National Academy Press, c2001.

• Doyle, L., Keogh, B., & Morrissey, J. (2007). Caring for patients with suicidal behaviour: an exploratory study. British Journal Of Nursing (Mark Allen Publishing), 16(19), 1218-1222.

• The Joint Commission. (2012). 2012 hospital national patient safety goals. Retrieved from http://www.jointcommission.org/assets/1/6/2012_NPSG_HAP.pdf.

References Continued• The Joint Commission. (2012). National patient safety goals effective January 1,

2012. Retrieved from http://www.jointcommission.org/assets/1/6/NPSG_Chapter_Jan2012_BHC.pdf.

• The Joint Commission. (2008). Suicide Risk Reduction - NPSG - Goal 15 - 15.01.01. Retrieved from http://www.jointcommission.org/mobile/standards_information/jcfaqdetails.aspx?StandardsFAQId=166&StandardsFAQChapterId=77.

• Knox, K. L., Stanley, B., Currier, ,. W., Brenner, L., Ghahramanlou-Holloway, M., & Brown, G. (2012). An Emergency Department-Based Brief Intervention for Veterans at Risk for Suicide (SAFE VET). American Journal Of Public Health,102(S1), S33-S37. doi:10.2105/AJPH.2011.300501

• Larkin, G., & Beautrais, A. L. (2010). Emergency departments are underutilized sites for suicide prevention. Crisis: The Journal Of Crisis Intervention And Suicide Prevention, 31(1), 1-6. doi:10.1027/0227-5910/a000001

References Continued• Pompili, M., Innamorati, M., Serafini, G., Forte, A., Cittadini, A., Mancinelli, I., & ...

Tatarelli, R. (2011). Suicide Attempters in the Emergency Department Before Hospitalization in a Psychiatric Ward. Perspectives In Psychiatric Care,47(1), 23-34. doi:10.1111/j.1744-6163.2010.00263.x

• Sarah A., T., Ashley F., S., Edwin D., B., Ivan, M., & Carlos A. Camargo, J. r. (n.d). Trends in US emergency department visits for attempted suicide and self-inflicted injury, 1993–2008. General Hospital Psychiatry, doi:10.1016/j.genhosppsych.2012.03.020

• Suicides in the hospital: the liability risk nobody wants to talk about: most prevention focused on psych care, but ED also is high risk for suicides. (2011). Healthcare Risk Management, 33(3), 25-28.

• Vaiva, G. G., Ducrocq, F. F., & Meyer, P. P. (2007). Psychiatric telephone contact following emergency department discharge reduces suicide re-attempts in people originally admitted for attempted suicide. Evidence Based Mental Health,10(1), 19