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Joint Commission issues more guidance designed to help healthcare facilities reduce suicides


April 1, 2018

Just when you thought you had your suicide prevention safeguards in place, things are about to change again.

The Joint Commission has issued more guidance designed to help healthcare facilities reduce suicides and stay in compliance with what seems like ever-changing standards.

You may recall that, in acknowledgment that suicide is the 10th leading cause of death and claims more lives than traffic accidents or homicides, the accreditor issued Sentinel Alert #56: Detecting and Treating Suicide Ideation in All Settings in February 2016 as a way of bringing attention to the problem.

Further, surveyors were ordered to immediately start placing more emphasis on the prevention of suicides in hospitals. This began March 1, 2016, and special stress was placed on the assessment of potential ligature (hanging) injuries, suicide, and self-harm monitoring. Extra focus was also placed on psychiatric hospitals and inpatient psychiatric patient areas in general hospitals.

As a result, an expert panel last summer issued 13 recommendations for hospitals to help them create a safer environment that removes ligature and suicide risks from inpatient acute and psychiatric units. The recommendations were published in an article in the November 2017 Perspectives titled “Special Report: Suicide Prevention in Health Care Settings.”

Those recommendations from the first two panels, which focused on things such as drop ceilings and toilet seats, were specific to inpatient units in both psychiatric and general acute care hospitals, in addition to emergency rooms.

According to the Perspectives article, a third expert panel met October 11, 2017 to focus on the prevention of suicide in other behavioral healthcare settings, such as residential treatment, partial hospitalization, intensive outpatient, and outpatient treatment programs.

As a result, three more recommendations were issued by The Joint Commission for these facilities. Specifically, the new recommendations are as follows:

The panel decided that these specific settings do not need to be ligature resistant, defined as not having places where a cord, rope, bedsheet, or other material “can be looped or tied to create a sustainable point of attachment that may result in self-harm or loss of life.” The panel concluded that these facilities provide care that requires less restriction than locked units; therefore, creating a ligature-resistant environment may not prevent patients from attempting suicide because the patients are able to exit the facility. The panel also assumes that patients in these facilities have been assessed and determined to be at low near-term risk for self-harm, and therefore appropriate for placement in a level of care that is less restrictive than an inpatient psychiatric setting.

Next, (and this goes for all facilities, really), a risk assessment needs to be conducted to identify things in the environment that patients could use to harm themselves, visitors, and/or staff. These items should be removed and placed in a secure location (e.g., putting sharp cooking utensils in a locked drawer) when possible. Staff training needs to focus on awareness of the environment and how to keep an eye out for things that may pose a serious risk to a patient who could develop suicidal ideation. Staff training should also teach awareness of techniques and protocols to keep patients safe until they can be stabilized and/or transferred to a higher level of care. These patients could have a change in mental state based on some trigger within the environment or in their treatment, and staff need to be trained properly.

Lastly, these facilities should have policies and procedures implemented to address how to manage a patient who may experience an increase in symptoms that could result in self-harm or suicide.

A fourth expert panel met December 8, 2017, to develop recommendations for suicide risk assessment and key components for safe monitoring of high-risk patients. Recommendations are still in process and will be added when completed.

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