i have a question about su

Jewelrmn · Feb 3, 2004

You are right, these sorts of things should not happen, but unfortunately do. Keeing people on special obs is designed to prevent them commiting self harm or suicide, or from hurting others. The difficulty is in choosing which level of special obs is required. The easiest way would be to nurse everyone on a one to one basis (at the very least), however this is very intrusive nursing, and not always therapeutic. We look to our risk management strategies to help ascertain which level of special obs we need to apply. Unfortunately you cannot eliminate all risk, and sometimes things go wrong. 15 minute obs are designed to give patients some degree of privacy, the nurses must ascertain the whereabouts of the patient every 15 minutes and ensure their wellbeing. It is very possible for someone to take their life, or the life of others in this time. A higher obs level would have been appropriate in this instance, but we are all wise after the event, and though I do not know about this situation other than what you write, I expect that the risk management system in place did not highlight the need for them.

I'm so sorry for your loss, my thoughts go out to you and everyone else affected by this tragedy.

catz · Feb 3, 2004

ty julie, i appreciate your thoughts.

elkpark · Feb 4, 2004

I agree with everything jewelrmn said, and I'm v. sorry for your loss. Losing a loved one through suicide is a terrible thing.

And, yes, it is possible for someone to kill him/herself in 15 minutes. I am personally aware of several similar situations (I've been a psych nurse for a couple decades now). Although the checks are referred to as "15 minute" checks, they are really _supposed_ to be done on a staggered, random basis (within each 15 minute block of time) so that people don't become confident that they have 15 uninterrupted minutes to do whatever they want after staff check on them.

As jewelrmn said, the "gold standard" would be to keep everyone at risk on constant observation, but that is considered a violation of people's civil rights and right to privacy unless there is no other way to keep someone safe. In psych settings in the US, you have a legal right to care in the "least restrictive setting," and constant 1:1 observation is pretty darned restrictive. And even constant observation is not foolproof ... One of the challenges of psych treatment is the judgment involved in deciding what level of observation is most appropriate for a particular client.

The sad reality is that someone who is determined to kill him/herself will probably find a way. Just the fact that someone expired on a psych unit doesn't necessarily mean that the staff did anything wrong or provided substandard care. If you are really concerned about the care that your friend received, your state agency that licenses hospitals probably has an 1-800 complaint line. I work for the agency in my state that investigates complaints about psych units, and we go to the hospitals and investigate complaints and suspicious or unusual deaths (in fact, state law in my state requires that hospitals notify us themselves of any suicides that occur on psych units). There is a similar system in place in every state.

Again, I'm v. sorry for your loss. Best wishes --

elkpark · Feb 4, 2004

Just noticed, when I was taken back to the original thread, that you are posting from England, so all the stuff I said about state agencies and US legal rights wouldn't necessarily apply (but I would guess there is probably a similar regulatory system in place there ...)

catz · Feb 4, 2004

thanks, ellpark, its interesting info nyway.

im guessin they did investigate, well i would assume so nyway but since im not a realative or nything i guess i gotta leve it be n hope that everyne involved is ok.

thank you

Eviene · Feb 9, 2004

Sorry to hear about your friend. It will be investigated by the trust.

TitaniaSidhe · Feb 11, 2004

Yes it is very possible to harm/kill ones self in 15 minutes, I have sadly been wittness to just that over the years working locked admissions. In the facillity where I work we do not have Q15min. checks but rather all patients needing observation are on constant observation of either arms length or within eyesight. Perhaps this is considered intrusive but at all costs the safety of the patient must be kept as the first priority. Sadly sometimes even this high level of obervation is not even enough....

I am truely sorry for your loss.

catz · Feb 12, 2004

thank you, i m sure hope it wil be investigated, i only hope something comes out of it that will help future patients,

zambezi, BSN, RN · Feb 12, 2004

I too am sorry for your loss. I don't work psych...however, I have a question. Do the seclusion rooms have cameras in them? I work in critical care and we have camera rooms...just curious to see what the norm is.

lucianne · Feb 12, 2004

Ours don't because we are a child/adolescent unit and per our policy, no child is ever in "seclusion" alone. I think most adult units with seclusion rooms do have cameras in them and I know of at least one adolescent unit my area that has a monitored seclusion room.

Jewelrmn · Feb 15, 2004

I too am sorry for your loss. I don't work psych...however, I have a question. Do the seclusion rooms have cameras in them? I work in critical care and we have camera rooms...just curious to see what the norm is.

Within my trust, seclusion rooms do not have camera's and this practice, as far as I know, is not usual in the UK. In fact, the use of locked rooms is now deterred, especially since we adopted the civil rights act in the uk, as this can be seen as an infringement. Special obs are completed within the ward area, and it has been known to nurse people who are violent or at risk on 2, 3, or even 4 to 1 obs within my own trust. It is important to remember, that people who suffer from mental illness are still people and should be treated with the same respect you or I receive. It is unfortunate however, that through illness, they are unable to exercise the same amount of control that we do.

N.B. they may still use camera's in special hospitals such as Broadmoor :) :) , but I cannot attest to this.