Suicide screening

Posted

Wondering if there is any feedback about the best way to get the ASQ Suicide screen to all patients that come through the ED. I work at a large pediatric hospital and right now our protocol is to give all patients >11yo a tablet to complete while in the ED. We're still only at 50% compliance. Any suggestions to get our numbers up?

Not sure I understand.  If they don't use the tablet, can't you just ask them the questions?

PollywogNP, ADN, BSN, MSN, LPN, NP

Specializes in Med-Surg/Tele/ER/Urgent Care. Has 44 years experience.

I work in FQHC Family Practice clinic. We have the questions (PHQ) in large font laminated & use dry erase markers, the the points are tallied & entered in EMR. Our school based health centers use tablets. We have the question in English & Spanish.

17 hours ago, Samantha Falkowski said:

Any suggestions to get our numbers up?

That would depend upon why the screenings aren't getting done. As already mentioned, not only are tablet questionnaires not being filled out, no one is asking the questions verbally. Why?

Staffing? Likely. What has your hospital done to make sure that there is adequate staffing to screen all patients without any discretion?

Understand that while there are arguments to be made for universal screening, there are also arguments against it. In addition, many of these efforts stem from the related NPSG (national patient safety goal), which specifically states that the goal is intended to be applied to patients whose primary problem is mental/emotional/behavioral health-related. Maybe part of your problem is that some of your patients don't find it relevant to their reason for visit.

And there are possibly dozens of other reasons. I'm not too impressed when people want to know how they can get compliance, how they can reach a certain goal or number seemingly without having investigated any of the whys. With that sort of approach, I suppose the reason people don't fill out your questionnaires is the same reason I don't call the number on the restaurant receipt and complete their survey--I don't care and they don't appear to care too much either; they just want to say they made some kind of effort.

This is a bit of a sidetrack but-

In 17 years, I have never had somebody without a relevant chief complaint or history turn out to be suicidal.

Is there any evidence that screening a grandmother with an ankle sprain for suicide has benefits?

I ask, because, at least where I work, there is a negative aspect of our routine screening.  We ask questions as part of a routine, as we are checking boxes.  99/100 times it is a meaningless hoop to jump through.  I believe that overuse of this tool results in something similar alarm fatigue.  When you put everybody on a monitor, you are more likely to miss an adverse event with somebody who is actually sick.

Side track here, but interested in anybody's thoughts.

7 hours ago, hherrn said:

In 17 years, I have never had somebody without a relevant chief complaint or history turn out to be suicidal.

Is there any evidence that screening a grandmother with an ankle sprain for suicide has benefits?

I ask, because, at least where I work, there is a negative aspect of our routine screening.  We ask questions as part of a routine, as we are checking boxes.  99/100 times it is a meaningless hoop to jump through.  I believe that overuse of this tool results in something similar alarm fatigue.  When you put everybody on a monitor, you are more likely to miss an adverse event with somebody who is actually sick.

Heck yes; wholeheartedly agree. In fact I had quite the verbal back-and-forth row trying to convey these exact concepts in a discussion on this forum a few years back. I say the exact same--granted I do seem to have a skill related to intuition and reading/understanding people, but despite taking the time to do the screening in as "present" a way possible I have never encountered a surprise-positive screen.

Still, apparently my position on this is attacked by reducing it to "but isn't one life worth it" and attempts were made to make me look despicable/soul-less/uncaring over the matter.

I more than just agree with the bolded portion of your comment specifically - I think there could actually be a detriment/danger involved in what is clearly check-box screening. For goodness' sake people aren't idiots, they can perceive when someone isn't in-tune, doesn't care, just needs to get something done--including patients who are struggling with thoughts. How might they feel when some one rushes in and, amongst dozens of other little check-listy things rushes through, "and do you feel like hurting or killing yourself?" That actually could be an experience that makes them feel like "aw, screw it" when they were considering divulging something that was bothering them but then they perceived that even people at the ED didn't really care too much.

For those interested, here is the document related to Hospital NPSG 15 (approximately pg 9).

35 minutes ago, JKL33 said:

Still, apparently my position on this is attacked by reducing it to "but isn't one life worth it" and attempts were made to make me look despicable/soul-less/uncaring over the matter.

 

Actually, no.  One life is not worth it. As a society, we make these decisions all the time.  We could save thousands of lives yearly by raising the driving age, for example, but we have decided that those deaths are worth it so the kids can drive themselves around and parents won't have to. 

In one encounter, there are only a certain number of assesments or interventions a nurse can do.  The focus should be on evidence based practice with measurable results.  And time, like money, is a limited resource and should be put to where it does the most good.

I am not flat out saying that the screening is not a good bang for the buck.  My impression is that it is not, but would be open to any data to the contrary.

6 hours ago, hherrn said:

Actually, no.  One life is not worth it. As a society, we make these decisions all the time.  We could save thousands of lives yearly by raising the driving age, for example, but we have decided that those deaths are worth it so the kids can drive themselves around and parents won't have to. 

That is a perspective I've heard/considered.

Another is that, sure, someone's life is worth it. The problem is that screening inappropriately is actually wasting resources that could be better channeled. Many of these screenings are about as useless as some of the temperature screenings I've seen in the past year. But--it looks like people are doing things to keep everybody safe.

I have a lot of thoughts about the topic. It isn't black and white. For example, although I have an interest in children's struggles with anxiety, depression and other mental health disorders and stressors, I do not believe that we need to continually ask them--completely independently of any actual assessment or knowledge of them--whether they perhaps feel like killing themselves. There are ramifications to the policies we enact in order to appear that we are doing something about a problem.

canoehead, BSN, RN

Specializes in ER. Has 30 years experience.

We have seven screenings to do already. Nursing is not a census bureau. The ER is all about zooming in on that one emergent complaint and moving on, not a full life assessment.