Suicide patients

limaRN, BSN, RN · Mar 24, 2013

Ehh.. A lot can happen in 15 mins. I'm not sure of the legality or not though. I work at a hospital where all patients who are suicidal have a 1:1 sitter. I'd be extremely nervous without one. My mom is also a nurse and had been for years. In the 90's at the hospital where she worked they were not required to have sitters just q15 min checks on patients. She had one patient where she came back to check on after 15 mins and found him rocking up and down in bed. She asked what he was doing and he didn't answer just kept rocking so she came in and pulled back the covers. He had found razor blades somewhere and was scratching his legs with them. He then took the razor blade and slit his throat before she could stop him... Needless to say that hospital now has 1:1 sitters for suicidal patients. I would just hate to see something bad happen before the policy is changed there.

SleeepyRN · Mar 25, 2013

I was working at 1 hospital suicides were 1:1. Now I work in the middle of nowhere & are expected 2 take suicide Pts w/regular pt load no sitter, & chart q15min. Is this legal?

Wow. Just think for a moment what that says about the hospital. It says 'we care more about money than our patients." When I was a sitter, our hospital was excellent with providing 1:1 observation for not only suicides, but almost everyone who were major fall risks who were non compliant (confused and trying to get out of bed despite being told to use the call light.) Then when I started working the floor as a tech, they started only providing sitters for suicide risks. And I thought THAT was bad. Geez. I know much of it is ignorance on my part as to how budgeting works and how these decisions to eliminate positions are made, but how is it not common sense that sitters are an investment and actually end up saving money. For example, a confused Medicare patient falls, requires radiology imaging, then requires extra care for the injury sustained in addition to the chief reason they are in the hospital. The hospital is most likely not going to get reimbursed for all of that. There were very few patients I 'sat" for that I didn't have to intervene in any way. So doing the math, that's hundreds of falls and injuries (and reinjuries from a fresh surgery) that I prevented. If I were part of the committee or whoever making these ridiculous, UNRESPONSIBLE, cut backs, I imagine I would think "hmmm, do I want to pay $90/shift for a sitter, or thousands for 1 patient when something goes wrong. Because its usually a matter of when, not if. I've heard of hospitals get rid of sitters for a while only to bring them back again when stuff started hitting the fan.

MrChicagoRN, RN · Mar 25, 2013

There are different levels of suicidality and levels of risk. Some people may in imminent danger, while others may be at very low risk. Most hospitals have different levels of watches. A SP1 may require 1:1, while SP2 may be on q15' checks.

What does your Policy and procedure say?

SleeepyRN · Mar 25, 2013

There are different levels of suicidality and levels of risk. Some people may in imminent danger, while others may be at very low risk. Most hospitals have different levels of watches. A SP1 may require 1:1, while SP2 may be on q15' checks.
What does your Policy and procedure say?

Human emotions are not a math equation you can predict. Who really dares to predict that an "SP2" won't suddenly change to an "SP1". That's playing God to me. I would currently probably be classed as a level 2 (I'm waiting for my Lexapro to kick back in) as my thoughts lately have been consumed with not wanting to be alive. Because I have a good support system and have great insight, I trust that as of right now, I won't try to kill myself. Tomorrow however, anything could transpire that would send me over the edge. I HAVE made a real attempt at suicide before. It was really a miracle I lived. So I know first hand there are different levels of risk. But that risk level could change at the drop of a dime. I'm not currently working and won't return to work til my Lexapro starts working again and I can trust that I will once again give my all to my patients.

MrChicagoRN, RN · Mar 26, 2013

Human emotions are not a math equation you can predict. Who really dares to predict that an "SP2" won't suddenly change to an "SP1". That's playing God to me.

Are you suggesting that once a person has an almost lethal attempt, that they should forever be on one to one while hospitalized? Would assessing the risk, and implementing the appropriate level of care be "playing God?"

You are absolutely correct that suicide assessment is not a formula. That's why a person needs good clinical assessment, and reassessment. Interventions are adjusted as needing.

Level of suicidality may increase, or decrease over time. That's why it's critical to talk to your patient, know them, form a therapeutic alliance, and involve the patient in their care.

blugreeneyez · Mar 26, 2013

Unfortunately that's the way it is!

SleeepyRN · Mar 26, 2013

Are you suggesting that once a person has an almost lethal attempt, that they should forever be on one to one while hospitalized? Would assessing the risk, and implementing the appropriate level of care be "playing God?"
You are absolutely correct that suicide assessment is not a formula. That's why a person needs good clinical assessment, and reassessment. Interventions are adjusted as needing.
Level of suicidality may increase, or decrease over time. That's why it's critical to talk to your patient, know them, form a therapeutic alliance, and involve the patient in their care.

No, I absolutely do not think that one should always be on 1:1 if having to be hospitalized again for a different reason. I don't think assessing is playing god. I think assessing that there IS a risk, but not taking appropriate interventions (1:1) because one believes that "well, they aren't THAT great a risk" is dangerous. It takes quite some time to assess a patient and their level of risk. That is why it is smarter to immediately place all suicide risks on 1:1, then continue to assess and have the psychiatrist talk with the patient. Then if their risk is classified as low, remove them from 1:1.

KelRN215, BSN, RN · Mar 26, 2013

I was working at 1 hospital suicides were 1:1. Now I work in the middle of nowhere & are expected 2 take suicide Pts w/regular pt load no sitter, & chart q15min. Is this legal?

I'm not sure that there are laws as to how a facility must monitor a patient who has expressed suicidal ideation because I know policies can vary between facilities and laws obviously vary between states. In my state, a suicide attempt will win you a 72 hr psych hold. Thinking back to my psych clinical in nursing school- it was at a world renowned psychiatric hospital and the unit I was on had a lot of failed suicide attempts. None of the patients were on 1:1 but they were on a different "level" which meant more frequent checks, I think? This was a long time ago so any psych nurses can feel free to chime in and correct me.

When I worked in acute care, any patient who expressed suicidal ideation or was admitted with a failed suicide attempt (saw a few teenagers in my day who tried overdosing on their prescribed anti-epileptics which bought them admission to my floor) had a 1:1 sitter who was required to be within arms length at all times... the patient was not permitted to be alone, ever. Once they could contract for safety, the restrictions were loosened.

There are, of course, a wide range of possibilities for patients with suicidality. If you had asked me when I was 21 years old, I probably would have admitted to being suicidal and wanting to die, but I never actually had a plan. "I hate my life and want to die" is different than "I have access to a gun and if you let me leave I'm going to blow my brains out" which is still different than "if you leave me I'm going to hang myself with my bed sheets."

I was once sent to the ER at a local hospital for a psych evaluation due to SI. They put me in a room with a rent-a-cop at the door, a psychiatrist came in, I said "I'm not going to kill myself" and they let me leave.

lilredmc · Apr 6, 2013

I would like 2 add I have worked part time as an agency nurse & 5 other hospitals n my area ALWAYS makes them 1:1 until cleared by psych or md. My Aunt works n Houston & Methodist makes them 1:1. We've already had a pt attempt 2 hang himself while the only 2 nurses were in a rm cleaning a pt. There was NO ONE around 2 watch the pt & THAT happens frequently! The nurses give bathes & can't watch the unit. SO OBVIOUSLY what we r doing is not safe, but we don't know how 2 get management 2 c this as unrealistic! Even after the attempted hanging the pt was coded brought back & CHANGES were SUPPOSE 2 b made!