Date
of Last Review: 4/22/2011
SME: Chief Nurse Officer
The safety of patients is of utmost importance. Patients who are potentially dangerous to
themselves are closely observed to prevent them from harm.
Procedure:
An
order for suicide precautions is written by a physician, or by a registered
nurse as an independent nursing intervention. A physician’s order must be obtained within 24 hours of the nursing
order. The order must include reason
and duration.
Suicide precautions are
instituted immediately by the medical or nursing staff when a patient
verbalizes and/or makes an overt suicidal attempt, including self-mutilation
attempts or has history. Documentation of the specific
behavior necessitating precautions must be made in the progress notes. Thereafter, the RN will document an
assessment on the Nursing
Flow Sheet/Progress Notes. If there is an overt suicidal attempt, a registered nurse assesses the patient and notifies the physician. The patient is advised when precautions are being implemented and discontinued.
As part of the assessment process, the physician and nurse determine the patient's need for one-to-one staff supervision.
If the patient is on one-to-one, the patient is
accompanied by the assigned staff member during bathing, showering
and shaving. The staff member remains
outside the bathroom door (leaving the door slightly ajar) during hygiene and
toileting activities to allow for privacy. If a staff member must enter, it is to be female staff to female patient
and male staff to male patient when possible.
The patient is monitored and documentation recorded on the Precautions Checklist every fifteen minutes. The order for suicide precautions is reviewed daily, and it will be renewed, as indicated, by the physician (with input from the treatment team).
The patient is not permitted to leave the unit until the precaution is discontinued (with the exception of patients who may participate in courtyard activities at the RN discretion on the Child/Adolescent Units).
All packages, and clothes brought in to the patient are
carefully inspected by the nursing staff in the presence of the patient.
The patient's mouth is inspected after giving medication
in tablet form to make sure it has been swallowed; liquid concentrates are
preferable.
The patient and room are checked once per shift for
hazardous items (to include sharp objects, glass, belts, etc.) and this is
documented on the Precautions Checklist.
The assigned staff member continually assesses the
patient's condition and response to suicidal status. Each shift documents as follows:
·
Safety checks of patient and room
·
Observation of patient every fifteen minutes using the
Precautions Checklist
·
The assessment is documented by the R.N. after each shift
using the Nursing Flow Sheet/Progress Notes.
Related
Standards:
JCAHO CC 2.1
JCAHO TX 1.2
JCAHO PI 2.1, PI 4.4
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