Patients on suicide precautions-what is your facility's policy?

[deespoohbear]

I work for a small hospital. We have a general med/surg floor with 32 beds and a 4 bed ICU. Every once in awhile, we get a patient who has attempted suicide. Usually these patients are medically stable and just need to be observed overnight until other healthcare arrangements can be made. Our administration believes these people can be placed on our general floor on suicide precautions. This means the patient has to be checked every 15 minutes and documented. When I have 6 or 7 other patients, this becomes rather difficult. We usually try to get these patients admitted to the ICU because of the lower patient to staff ratio, plus the patient can be in plain sight at all times. I do not feel comfortable taking a patient on suicide precautions on the general floor because I cannot observe them like they need to be observed. These patients usually don't have a family member or friend who is reliable enough to be trusted to watch them. So, we usually end up in an arguement with the ER doctor and possibly nursing administration about where these people need to be admitted. I was wondering what other facilitlies policies were about patients on suicide precautions and staffing. Any ideas how I can convince admininstration these people do not belong on our floor unless the hospital can provide 1:1 care for them?

[nilepoc]

I currently work in an ICU, I think that placing them in the ICU is the wrong move. It is expensive, and in our busy institution, it is wasteful of resources.

What we do, is pay someone to sit in the room with the patient 24/7. The sitters come from our casual pool tech and secretary staff. The only thing they do for their 12 hour shift, is sit with the patient. Our hospital has found that this aproach is cheaper than using an ICU bed.

Good luck

[Dyno]

Scary stuff. If pt needs to be on visual obs & is a risk then they should be in a psych unit where one nurse usually takes responsibility for all visual obs. If this is unavailable then a special (1:1) for the shift or at least a lower pt/nurse ratio.

Maybe a bed within view of the nurse's station would help but still a huge risk.

Keep your documentation up to scratch and voice your concerns.

[Dyno]

I agree with nilepoc, ICU bed is way too expensive.

Use a 'sitter', nurse aide, or what ever you have in your hospital.

[debbyed]

These patients do not need ICU if they are stable but they do need 1:1 sitter within arms lenght if they are not in a locked down safe secure environment.

Do not accept these patients unless you can provide a safe secure environment for them. From dealing with multiple sucidial patients I know that it only takes a blink of an eye for them to act out, sometimes fatally. If a patient is on sucide percautions and they succeed in harming or killing themselves (or anybody else) on your watch than you are responsible.

Be very, very careful...see what your hospital's WRITTEN policy is, they must have one to be accredited...Contact your state board for their opinion...I can't stress enough be very, very careful. It only takes one lost lawsuit to destroy your life as you know it... physically, emotionally and financially.

[Doey, BSN, RN]

I agree with the others. ICU is too expensive and a waste of a bed if medically stable. Where I work any time a pt. is on suicide precautions and is admitted or transferred to a regular floor there must be a sitter provided 24/7 until the pt can be medically cleared to go to psych or has been cleared off suicide precautions. It can't possibly be guaranteed that someone can check the pt q15" when you have other pts to care for. And what can happen in that 15"? A few yrs ago a friend told me about a pt that was on suicide precautions and was to be checked q15". Well someone did check on him, found him to look like he was asleep. Came back 15" later and found he had hung himself. Like debbyed said it only takes a blink of an eye.

[deespoohbear]

Our psych unit won't take the patients unless they are medically stable. We don't have any extra staff that we can place in the room for 24/7 care. I know that is what needs to be done, but I don't know how to convince the higher ups. Our ICU is pretty much a glorified med/surg unit. Most of the people in our ICU would be placed in a regular med/surg or tele bed in a larger hospital. I guess if I am told that I am going to get a patient on suicide precautions I will just demand that the other nurses absorb my load, or that admininstration can find someone to sit with that patient 24/7. Thanks for all the input.

[tiger]

it is amazing to me that on our unit a little old lady that says "i just want to die" and has no intention of attempting to kill herself will be placed on 1:1 supervision even if the rest of the staff works short. but a chi who has eloped 2-3 times is still not 1:1. i'm talking confused chi ending up blocks away. or a pt. that is confused that can walk but not steady and has fallen several times. we are not allowed to restrain them.

[misti_z]

We have a big, good psyh hospital here in town...if a bed is not available at that hospital they are kept in the ER in video monitored room---so i'm told

[krisfroggie]

For OD in our hopsital, if the observation unit is cosed, the patient is kept in the PICU, I agree with many of you that it is a great waist if funds and the sitter option is not utalized. ( I never have been able to understand administrations rational for this.) The only exception of course is depending what is injested and whether cardiac monitoring in necessary for a time. We are good about completing all psy evals and proper placement by the next day, until transfered, so the stay is usually short.

[night owl]

I find it amazing that a pt would even be placed in a hospital, on a med /sug unit to be checked q15 min. for attempting suicide...What are you checking for? That he is ok? Is he alive or is he dead? Is he attempting again? A person who is brought in for attempted suicide doesn't need to be checked q15 min, he needs CONSTANT observation at arms length! And why isn't he/s admitted to the psych unit or a psych facility where his psych problems can be addressed??? Like previous posters stated alot can happen in 15 min. Realistically speaking, that pt does not get checked EVERY 15 min staying on a med surg unit. What if you're busy with another pt who stated , "I have chest pain!" Chances are you're going to forget about that suicide pt. and bingo that's when things happen.

We have a resident right now on COS (close observation status)

and has been since last wednesday. Over the weekend one of the NAs observing him found a paring type knife under his pillow and everyone who observed him 1:1 has no idea when he even put it there. The resident denies putting it there and states that he never had a knife and someone is trying to frame him. He has no visitors and he never gets OOB. He was checked for all contraban when he was placed on COS and no knife was found. The point is, if he had the "opportunity," he may have tried to use it.

This is the time of year when people become depressed and may attempt suicide. Prior to the holidays, facilities such as LTC need to have mandatory inservices dealing with s/s of depression, suicide prevention and protocol for observation status COS or Group observation. This class is as important as a CPR mandatory refresher course because you just might save a life, but in a different way.

[donmurray]

Folowing on from the need for training in s/s etc. Rn's, preferably psych. are the people who should be doing the 1/1 obs. As someone posted on another thread, regarding triage, experienced, skilled staff is what is needed