| Principal Investigator: | Patricia A. Allen, RN, BSN, CARN |
| Co-Principal Investigators/Collaborators: | Rolaine Weeks, Shanna Cullums |
| Organization: | Riverside Methodist Hospital Behavioral Health |
Abstract
Problem
Individuals can commit suicide anywhere and anytime. Healthcare organizations are not immune to this tragedy; in fact, 5-6% of suicides are committed in hospitals.
Evidence
According to JCAHO the most frequently occurring sentinel event is inpatient suicide. Current research suggests that aggressive treatment of severe anxiety/agitation may reduce acute suicidal risk and violent outbursts and that the use of a tool to monitor behaviors and affect leads to earlier intervention (Temkin & Crotty, 2004).
Strategy
Clinical practice was reviewed and revised on the behavioral health unit as we sought to more readily recognize escalation and intervene more quickly through systematic monitoring for behaviors associated with increased risk of severe anxiety and/or agitation.
Practice Change
A modified precaution monitoring tool was developed and implemented following a review of the literature and input from the entire staff. The tool uses terminology that creates a common language to describe behaviors and affect. All staff received education on the terminology and documentation codes as well as signs and symptoms of anxiety and agitation. The monitoring of risk becomes a shared responsibility of the multidisciplinary team.
Evaluation
Since implementation of the tool, episodes of seclusion/restraint have been reduced on average by 75% as well as the rate of assaults and self harm incidents by 13.4% as compared to the previous 12 months.
Results
The safety of the environment has improved. The new monitoring process provides clinicians the opportunity to use early intervention techniques such as verbal de-escalation, administration of medications, etc. to help reduce the number of restraint episodes, violent outbursts and parasuicidal behaviors.
Recommendations
The tool has potential application on non-behavioral health units when combined with staff education in the recognition of risk behaviors and use of common terms to describe affect and behavior.
Bibliography
- Busch, K., Fawcett, J. & Jacobs, D. (2003). Clinical correlates of inpatient suicide. Journal of Clinical Psychiatry, 64, 14–19.
- Joint Commission on Accreditation of Healthcare Organizations. (2003). Sentinel event statistics. Retrieved November 22, 2006, from http://www.jcaho.org/accredited+organizations/ambulatory+care/
sentinel+events/se _stats.htm. - Johnson, M. (2004). Violence on inpatient psychiatric units: state of the science. Journal of the American Psychiatric Nurses Association, 10 (3), 113–21.
- Temkin, T. & Crotty, M. (2004). Suicide and other risk monitoring in inpatient psychiatry. Journal of the American Psychiatric Nurses Association, 10 (2), 73–80.