What is your policy for suicidal patients?

[PinkRocksLikeMe]

When we have a patient come in claiming to be suicidal our doctor evaluates them and decides whether or not they will be a "1013" meaning they will be transferred to a MH facility (since we don't have one) whenever a bed becomes available. My problem is this, as you know when the patient comes in, goes through triage and gets called back when a bed is available they are not put in paper scrubs until they are deemed 1013. They can go out and smoke, they are told to ask a nursing staff to go with them but the never do. I think if someone comes through triage and claims to be suicidal they get the paper scrubs THEN, and all things are removed that they could use to hurt them, until the doctor comes in and we can initiate transfer. No going out and smoking or to make a call. What if they did something to themselves while they were outside, would we not be responsible? I was just wondering you guys policy and your feelings on what I have posted.

Thanks in advance

PS, the paper scrubs dont officially go on until after they are deemed 1013

[Roy Fokker, BSN, RN]

If the complaint is SI/HI/intoxication (drugs or alcohol) - the FIRST thing done is change out of street clothes, all belongings labeled and locked with security and a 1:1 observation initiated.

No ifs/buts/maybes.

And no, no going outside and smoking or whatever - even with "staff present". What if pt. decides to run/elope? What is staff going to do? Run after them? Call security? The cops?

IMO, it's an avoidable risk.

I think if someone comes through triage and claims to be suicidal they get the paper scrubs THEN, and all things are removed that they could use to hurt them, until the doctor comes in and we can initiate transfer.

This is the prudent thing to do. Protect the patient till evaluation and further disposition can be made.

cheers,

[EmergencyNrse]

Our policy...

No committing suicide @ the hospital.

You have to go somewhere else to do it.

[WillowNMe]

Same as Roy... Any threat of suicide, elopement, or danger to staff, they are put on a 1:1.

[Ashley_RN]

Same as Roy- pt out of street clothes & into gown with security at bedside for a 'search' of patient (people hide crazy things in crazy places) and 1:1 cannot be family member. The 1:1 aka "constant observer" remains at the pt beside/bathroom use/with visitors present (basically at all times) with pt always in view. They've undergone classes educating them on suicidal patients & the best way to interact, things to be watching for, etc. Also, they're not allowed to watch tv, bring their own belongings into room, or step out at any moment without coverage of another 1:1 or RN. Kitchen is also notified for a certain tray (cant think of what its called) but its all paper/plastic & pt is given a spork with all meals. A psych eval is placed immediately.

Can you tell we've had a suicide at our hospital

[DogWmn]

At my hospital we have patient sitters/observers who are with them 24/7 1:1- they are never left alone, the room is searched and all items considered dangerous are removed (a list is provided), food trays are styrofoam and plastic utensils and are checked going in and out of the room, doors remain open at all times, personal belongings are bagged and put in the nurses station, our hospital has a no smoking policy on campus so no smoking is allowed, they may not leave the room and if they attempt to or do we call a code gray and security arrives quickly.

[Simply Complicated]

So a patient comes in, says they are suicidal, and are pretty much treated like any non-suicidal patient until a Dr. assesses them, and changes their status? Doesn't make a whole lot of sense to me.

I work in psych, but when I worked medical, a suicidal patient was automatically made a 1:1 until they were deemed to not be a threat to themselves.

[loriangel14, RN]

Where I work they have to be sent out as well. We deem the "form 1" patients which is an automatic 72 hour hold. They are assigned a security guard to be with them at all times until they are transferred out to the nearby psych unit.They aren't allowed to go outside and they are in gowns in a room.

[lckrn2pa]

I work at a hospital years ago where a psych pt came in to be evaluated. I was off but during his treatment he ran out the ambulance bay doors and 2 blocks over the pt got the gun away from a police officers and unloaded the clip in the officer who was pronounced dead at scene. Psych pts are one on one with security and placed in paper gown. No questions asked and if they refuse then they are put in leathers then stripped and put in a gown.