Suicide screening for all is not needed - page 5

At my hospital every patient who comes in to the ER is supposed to be asked suicide screening questions. If they are admitted as an inpatient they are asked again. I don't think this is useful and... Read More

  1. by   The Incredible Nurse
    I believe this screening is important, even if it gets to be a bit repetitive to ask the same questions. It takes 10 seconds out of our time and could end up catching someone with suicidal ideations. Better to play it on the safe side, you may end up saving someone's life.
  2. by   JKL33
    Repetitiveness (as far as from the nurse's perspective) is not what is at issue here. Triage itself is of a repetitive nature; that isn't the issue.
  3. by   Susie2310
    The OP's question was about the effectiveness of suicide screening. Taking extra time to conduct this screening of all patients routinely at triage (or even later in the ER visit) along with other risk screening questions when the patient's chief complaint and symptoms indicate an unrelated acute illness, is wasting time and causing more stress for an already sick person that would be better spent expediting their evaluation and treatment (and also delays the triage of patients who are still waiting to be triaged). Triage is meant to quickly sort patients to prioritize how quickly they need to be seen and is not the place for a series of unrelated screening questions when a patient appears obviously ill and presents with a chief complaint and symptoms including vital signs that indicate this.
    Last edit by Susie2310 on Feb 11
  4. by   Susie2310
    A few years ago a family member was admitted to a med-surg unit with severe sepsis. The nurses seemed to have no sense of prioritization. My family member was fighting for their life and the nurse doing their admission was asking the risk assessment questions in a leisurely way; the fact that they didn't yet have any physician orders was much less of a concern to him/her. The little energy my family member had left that they were using to try to survive with was being used up trying to answer inane questions about suicidal thoughts and whether they were being abused while their vital organs were not perfusing properly and fluid resuscitation/antibiotics hadn't even started because no-one had obtained orders yet.
    Last edit by Susie2310 on Feb 12
  5. by   KeeperMom
    I agree that it should be asked every time to every patient.
    #1 it will cover my butt. Why? Because if I were ever standing before a judge and he/she were to ask me, "Ma'am. How do you know you asked Joe Smith if he felt suicidal when he was in your ER?" I can say with 100% confidence, "I know I asked him because I ask every patient that comes in for treatment. I do it the same way every time."
    #2 You just never know what's in a patient's head at the time. Maybe he's been seen five times for that belly pain but in reality he comes to the ER to be in a safe place. Maybe no one has given him much attention in previous visits and he never felt comfortable with other nurses. Maybe, just maybe, this time when he's in my room and one-on-one with me, he may feel comfortable with me and may say he is having suicidal thoughts but just never felt safe enough to say it out loud.

    The question IS an important part of my assessment. Every time.
  6. by   ThePsychWhisperer
    Quote from Susie2310
    The OP's question was about the effectiveness of suicide screening. Taking extra time to conduct this screening of all patients routinely at triage (or even later in the ER visit) along with other risk screening questions when the patient's chief complaint and symptoms indicate an unrelated acute illness, is wasting time and causing more stress for an already sick person that would be better spent expediting their evaluation and treatment (and also delays the triage of patients who are still waiting to be triaged). Triage is meant to quickly sort patients to prioritize how quickly they need to be seen and is not the place for a series of unrelated screening questions when a patient appears obviously ill and presents with a chief complaint and symptoms including vital signs that indicate this.
    Exactly how do you know for sure that the chief complaint isn't related to depression/SI? Sure, not everyone is going to say they are depressed or suicidal. I assume that you've heard of patients developing somatic symptoms such as intractable abdominal pain or migraines with no cause, and that these symptoms are sometimes associated with depression, albeit not always with suicidal ideation. Apart from patients that are ones and twos on the triage scale, a few seconds for the two whole questions addressing depression and SI in our ED triage system isn't too much to ask.
  7. by   ThePsychWhisperer
    Quote from Susie2310
    A few years ago a family member was admitted to a med-surg unit with severe sepsis. The nurses seemed to have no sense of prioritization. My family member was fighting for their life and the nurse doing their admission was asking the risk assessment questions in a leisurely way; the fact that they didn't yet have any physician orders was much less of a concern to him/her. The little energy my family member had left that they were using to try to survive with was being used up trying to answer inane questions about suicidal thoughts and whether they were being abused while their vital organs were not perfusing properly and fluid resuscitation/antibiotics hadn't even started because no-one had obtained orders yet.
    I will say here that perhaps the nurses on this unit should have been trained a little better in what really matters in periods of acuity.
  8. by   JKL33
    Quote from KeeperMom
    I agree that it should be asked every time to every patient.
    #1 it will cover my butt. Why? Because if I were ever standing before a judge and he/she were to ask me, "Ma'am. How do you know you asked Joe Smith if he felt suicidal when he was in your ER?" I can say with 100% confidence, "I know I asked him because I ask every patient that comes in for treatment. I do it the same way every time."
    #2 You just never know what's in a patient's head at the time. Maybe he's been seen five times for that belly pain but in reality he comes to the ER to be in a safe place. Maybe no one has given him much attention in previous visits and he never felt comfortable with other nurses. Maybe, just maybe, this time when he's in my room and one-on-one with me, he may feel comfortable with me and may say he is having suicidal thoughts but just never felt safe enough to say it out loud.

    The question IS an important part of my assessment. Every time.
    These are each compelling reasons.

    My only concern throughout this discussion has been that saying we are going to screen everyone makes us all feel great. We can sleep at night as far as this issue is concerned largely because of your item #1. However, the backdrop on which all of this is occuring is not actually very conducive to the desired outcome (which is not that we would simply be able to say we've screened everyone and call it good, but that we would actually uncover those in need of help w/ regard to SI/HI).

    I have uncovered patients via #2 because of the way I handle situations that concern me. I have never uncovered any concerns through a screening question but rather through what I felt was appropriate assessment at the time. Anyone is free to think whatever they want about me saying that I haven't uncovered any SI through "screening," - but I am making a distinction between what passes for screening (yet apparently still makes everyone feel very, very pious!) and actual careful assessment as warranted.
    Last edit by JKL33 on Feb 15
  9. by   JKL33
    Quote from ThePsychWhisperer
    Exactly how do you know for sure that the chief complaint isn't related to depression/SI? Sure, not everyone is going to say they are depressed or suicidal. I assume that you've heard of patients developing somatic symptoms such as intractable abdominal pain or migraines with no cause, and that these symptoms are sometimes associated with depression, albeit not always with suicidal ideation. Apart from patients that are ones and twos on the triage scale, a few seconds for the two whole questions addressing depression and SI in our ED triage system isn't too much to ask.
    You're right.

    That being the case, it says absolutely nothing about effectiveness.
  10. by   ThePsychWhisperer
    Quote from JKL33
    You're right.

    That being the case, it says absolutely nothing about effectiveness.
    And sometimes it isn't effective; I won't argue that point. But I would rather ask and chart that patient denied, as opposed to patient came in and hung self with bed sheet or jumped out window sometime during admission, ER triage nurse never asked about depression/SI, and therefore floor nurse and physicians were never made aware. I know it can get repetitive, trust. But it's as much a game of CYA as it is make administration happy.
  11. by   JKL33
    Quote from ThePsychWhisperer
    But it's as much a game of CYA as it is make administration happy.
    True.

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