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Suicide PrecautionsCrisis Intervention:The goal of crisis intervention is prompt recognition ofescalating behavior and early intervention to assist the patientin regaining behavioral controlTo ensure the protection of all patient rights while maintainingan acceptable level of patient/staff safety, all procedureslimiting a patient’s activities are implemented according torules and regulations of the Arkansas Department of Healthand other applicable standards
Suicide Precautions (continued)Level II Precautions: When “suicide precautions” without a specific level are ordered by the physician, Level II interventions are implemented Level II precautions means the patient is at moderate-high risk of self-injurious behavior Responsibility of staff members caring for Level II suicidal patients are: • Nursing (licensed or unlicensed) is assigned to one-to- one observation • This includes while toileting, sleeping, during visitation times and even during diagnostic procedures • The patient is restricted to the nursing unit unless accompanied by a member of the nursing staff
Suicide Precautions (continued)• Medications are given in oral liquid form to prevent hoarding of medication at the MD’s discretion• The patient is not allowed access to potentially harmful objects (belt, sharp objects, matches, cigarette lighters, glass containers, plastic bags, cleaning solutions, etc)• Patient is allowed to have visitors but staff observation is maintained throughout the visit• If at anytime nursing staff observes escalation of the patient’s suicide risk/behavior, the physician is notified immediately• Suicide precautions are explained to the patient and to all visitors entering the room *All patients admitted on a 72 hour hold are monitored in Level II Precautions*
Suicide Precautions (continued)Level I Precautions:A patient judged by the physician to be at somewhat lowerrisk of suicide is ordered Level I precautions.Nursing responsibilities for a level I patient include:• The staff is aware of the patient’s whereabouts and activities at all times• If leaving the unit, the patient is attended by a staff member (may be any hospital associate)• The patient is admitted or moved to a room centrally located and within view of the nursing station• The door remains open unless another person is with the patient
Suicide Precautions (continued)• Sharp objects may be used while the patient is observed by a staff member, but hazardous materials are not left in the patient’s possession when a staff associate is not physically present• These interventions are explained to the patient and all visitors• A specific staff person is designated to be responsible for the patient at all times during each shift• If the designated staff associate must leave the unit, information & responsibility for supervision of the patient is transferred to another staff associate
Suicide Precautions (continued)• The patient is checked at frequent but irregular intervals to ascertain safety and whereabouts• Closer observation of the patient is maintained at times when decreased numbers of staff are present or increased level of activity is present on the unit• To prevent hoarding of lethal quantities of meds, swallowing of meds is observed carefully• The patient may have visits with family/significant others without staff members present - instructions are given to visitors regarding restricted articles that are not to be given to the patient
Suicide Precautions (continued)Nursing Care for the Suicidal Patient: Assessment Parameters: Document information regarding past attempts, ideation, and family history upon admission Note behavior throughout the day, structured vs. unstructured unit activities, patient interaction with other people, task performance, activities, and attention span Observe, record, and report any mood changes Watch for behaviors such as decreased communication, conversations about death, disorientation, disinterest in surroundings, and concealing harmful objects
Suicide Precautions (continued) Nurse-Patient Interactions: Do not promise confidentiality regarding information received about suicide plans Discourage excessive discussion of previous attempts Convey an accepting, nonjudgmental attitude Encourage patient to ventilate feelings Do not belittle previous attempts as “gestures” or manipulative efforts Help the patient identify positive aspects of himself or his life situation Involve the patient in planning care and understanding interventions and assist the patient with identification of support systems for use at discharge
Suicide Precautions - 72 Hour HoldA patient is subject to involuntary detention or a 72 hour hold whendetermined to be a danger to themselves or othersWhen patients are placed in a 72 hour hold;• The physician must write or give the order• The 72 hours does not include weekends or holidays• The patient must receive a written copy of their rights AND have their rights READ ALOUD within 60 minutes of the hold order• Rights presentation occurs with a witness and the patient is asked to sign a statement whether they agree or disagree• The patient can disagree but not provoke the “hold”• Supervisor is notified when a patient is placed in a 72 hour hold• 72 hour hold patients are on Level II suicide precautions, which includes one-to-one observation