Suicide screening for all is not needed

  1. 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 adds to the plethora of screening questions that is overkill these days.

    I don't see the point in complicating a simple or serious medical problem/evaluation with a barrage of unrelated questions. Of course there appears on the computer a complicated rating system along with the screening that is utterly formulaic and impractical.

    Of course, with a psych presentation/problem these questions are appropriate and valid. But, asking the questions of people with physical complaints is opening up a can of worms. If someone with a broken arm says they attempted suicide years ago, what are we going to do? Nothing other than move on to the next question on the list, that gets longer each year.

    I suspect that these sorts of policies originate from the personal grief or guilt of someone in a regulatory role in healthcare. 'If only my brother had been screened for suicide in the ER when he broke his arm last year, he'd still be alive today!'.
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    About Emergent, RN

    Joined: Dec '13; Posts: 2,290; Likes: 16,620

    62 Comments

  3. by   Buckeye.nurse
    I agree that the nursing admission database can feel cumbersome at times. This is one question that I never skip over though. I've been surprised before at people who have answered yes to a depression/suicide screening question.

    In my 14 years as a nurse I have heard of patients who come in for a scheduled treatment, then screen positive, and had the round of chemo held while their increased depression and statements "I don't know if I want to keep fighting" or "I just want to die" are evaluated.

    It's kinda like the screening questions for domestic violence. Sometimes people won't say anything until asked. I make sure I ask.
  4. by   verene
    Sometimes people come to the ED or the clinic with a physical complaint in the hopes that the provider or nurse will ask them about their emotional state so it can be "okay" to talk about it. You also never know who has psych issues, some people are extremely good at masking, I've worked with more than one individual (both professional and personal) who on the outside seems more or less okay, but with some probing will reveal they have a hopelessness rating of -4 and a credible plan to kill themselves. I do think a screening (not a full assessment) is appropriate. Many suicide screening tools are only a question or two long so it doesn't add much time, unless the patient screens positive.
  5. by   klone
    Perhaps the screening questions can be couched a certain way as to make them more relevant. How I've approached is by asking them "Do you feel safe in the home?" (to cover the domestic violence question) and "Have you had any thoughts of harming yourself or anyone else in the last year?" (to cover SI/SA).

    But no, I don't agree with you that it should be skipped with some people or some chief complaints. You can't tell by looking at someone if they're struggling with mental health issues, and often, the ER is the only place a person will ever see a health professional.
  6. by   Flatline
    It is hard to understand their important until you yourself or a loved one has been in trouble.

    It is sometimes hard for people suffering to express their concerns until directly asked and if we don't ask, then who?

    I think we can all agree that depression and suicide is an alarming problem, asking a couple of questions that could literally be life saving cannot be that much of a burden can it? I would think those in the ED would be the most passionate about these screens considering they are often the first unit dealing the aftermath.
  7. by   Crush
    Asking the person directly if they are having thoughts of suicide is so important. As mentioned, there are alot of people who won't tell unless asked. Someone's mental state is not always something we can see, so asking the right questions are important.
  8. by   MunoRN
    The available evidence would seem to contradict the claim that suicide screening isn't necessary. While I would agree that utilizing broad, comprehensive suicide screening shouldn't be necessary, the problem is that when deciding who to screen is left up to common nursing judgement, it turns out we are really bad at recognizing who is at risk, which then necessitates removing any sort of "screen only if you feel it's necessary" exception.
  9. by   Ruas61
    You never know the silent pain someone is carrying. It might be the key to avoid a bad choice.
  10. by   beekee
    If you read the screening questions off the computer in a monotone voice, then the questions are probably not that useful. However, I look at my patients, sit next to them, and ask gently. You'd be amazed at the responses you'll get. The charge nurses have frequently commented on how often my patients admit to feeling depressed/suicidal when I happen to be the nurse. (And no, I don't work in psych).
  11. by   caliotter3
    I was put off by the emphasis on the one page mental health script a new PCP was following at my first visit. My dissatisfaction was only reinforced when on subsequent visits my new physician showed little involvement with the physical problems I presented, to the point that I am considering looking for a new doctor. Maybe this doc missed their true calling and should reconsider psychiatry instead of internal medicine.
  12. by   JKL33
    Quote from beekee
    If you read the screening questions off the computer in a monotone voice, then the questions are probably not that useful. However, I look at my patients, sit next to them, and ask gently. You'd be amazed at the responses you'll get. The charge nurses have frequently commented on how often my patients admit to feeling depressed/suicidal when I happen to be the nurse. (And no, I don't work in psych).
    The paradox here is that while the ED seems like a great opportunity because of the sheer number of people we see, that itself, along with the setting, makes for an extremely poor screening procedure (to the point of being embarrassing and awkward because of the glaring lack of time to develop rapport). Unfortunately it's not uncommon for screening to be made part of the triage process, to make matters worse. So here's how that goes:

    There's a list of questions. Basically you need to get through them AFAP. A general expectation for most triages is that they will take a few minutes or less. So, while getting vitals and double-checking the name/DOB:

    CC
    HPI
    Basic relevant med/surg hx
    How did you get to the ED today?
    Pain?
    Allergies?
    Ever been a smoker?
    Any chance you could be pregnant?
    Recent travel/been out of the country?
    Is English your primary language? If not, what is?
    Are you living in a safe place/any concerns about your living situation?
    Anyone hurting you?
    Any thoughts of hurting yourself or anyone else?

    No? Ok, great, have a seat and we'll call you when we have a bed.

    Mind you, I am trying to make eye contact, trying to convey my interest and attention, but the bottom line is to keep things rolling.

    I, too, have never had anyone surprise me with a response. Really....not once. That's not to say there are not depressed, suicidal or homicidal patients that I triage. Just that no one has ever surprised me with a response to the rapid-fire question routine, which was not thought up by anyone currently doing the job of triage, I can promise you.
  13. by   EllaBella1
    Almost positive that if a patient commits suicide in the hospital or within 24 hours of discharge it's a government reportable event, which opens hospitals up to investigations/legal implications. So the suicide screening is never gonna go away. Plus if it saves even a few lives isn't it worth a few measly questions?
  14. by   Emergent
    Quote from EllaBella1
    Almost positive that if a patient commits suicide in the hospital or within 24 hours of discharge it's a government reportable event, which opens hospitals up to investigations/legal implications. So the suicide screening is never gonna go away. Plus if it saves even a few lives isn't it worth a few measly questions?
    One "measly" question after another is death by a thousand cuts. The more is better approach is a poor way to accomplish important goals.

    It's like the reams of papers people checking have to sign. No one reads any of it!

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