Friday, March 2, 2018
Image: patient hospital room
Whether for a behavioral health concern or another medical reason, many individuals experiencing suicidal ideation end up in hospitals each year. According to the CDC, suicide is on the rise. It is now the 10th leading cause of death in the United States, claiming more than 40,000 lives annually. With that, hospitals and health systems are working to provide safe health care environments to prevent inpatient self-harm or suicide.

A Need for Overarching Guidelines
A number of health care facilities have been cited for hazards that could aid in patient self-harm or suicide. The Centers for Medicare and Medicaid Services (CMS) has recognized the need for overarching guidelines regarding what constitutes a ligature or self-harm risk, how citations should be reported, and how deficiencies should be corrected. CMS is currently working through interpretive guidance of the current standards/guidelines, which should be finalized within the next six months.

Adjustments to Prevent Inpatient Self-Harm
While CMS is finalizing guidance regarding ligature and self-harm risks, health systems can make the following design and procedure adjustments to reduce inpatient injury or death as a result of self-harm.

  • Design for the Patient
    Create welcoming spaces featuring open floor plans, high ceilings, realistic art, appropriate greenery, and large windows that let in bright, natural light. Waiting rooms, community spaces, and patient rooms with a more residential feel can create a calming and less intimidating environment.
  • Provide Timely Care
    Long wait times can cause stress and anxiety among patients. Work to streamline operations to provide timely, efficient care.
  • Put Proper Security Procedures into Place
    Reduced staff supervision increases the risk of inpatient self-harm. All patients, not just those with high risk for suicide, should be monitored closely - especially at night and during shift changes. Visitors, particularly those visiting a behavioral health unit, should be restricted to specific hours and required to sign-in.
  • Ensure that all Spaces follow Safety Precautions
    According to recent studies, 50% of completed inpatient suicides occur in mental health units while the other half occur in other areas of the hospital. Even with a designated behavioral health unit, patients at risk for self-harm may need to be relocated to a non-behavioral health unit for clinical or other reasons. When this is necessary, the organization must have a process in place to assess the risk for the patient and have a procedure to follow to mitigate risks to the patient. To better understand these risks, ASHE members can download a list of common ligature points and self-harm concerns categorized by room. This list provides an idea of what common self-harm issues/ligature points that need to be addressed to keep at risk patients safe.
  • Train Staff
    Not only should your clinical staff be continuously educated on screening and assessing those with suicidal ideation, they should be trained on the importance of inpatient self-harm risks factors. Suicide prevention should not be the job of one individual or team, but rather a holistic approach involving the entire workforce.

Learn more at the 2018 PDC Summit.
Those interested in learning more about making health care environments safer in regards to self-harm and ligature risks should consider attending the 2018 PDC Summit and participating in the Behavioral Health or Safety & Quality session tracks.

Planning your schedule? Check out the following sessions that will touch on behavioral health issues: