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Safe Harbor: Suicide Precautions Outside of the Behavioral Health Setting

Ellis, Donna MS, APN, ACNS-BC, WCC

Section Editor(s): EBRIGHT, PATRICIA DNS, RN, CNS; PATTEN, STEPHEN MSN, RN, CNS, CNOR, Conference Co-chairs

doi: 10.1097/01.NUR.0000348953.66940.0b
CONFERENCE ABSTRACTS: 2010 NACNS National Conference Abstracts: March 3-6, 2010, Portland, Oregon
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The project's purpose was to review the current process for care of patients on suicide precautions on units other than behavioral health. The objective was to implement interventions to reduce the risk of self-harm behaviors being carried out.

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Increasingly, adults with psychiatric disorders are placed on medical-surgical inpatient units for management of medical issues while simultaneously being monitored for suicide risk. The focus of staff on a medical-surgical unit is assessing and monitoring medical patients, which is much more complex when patients are also being observed for self-harm behaviors. In addition, the environment on medical-surgical units does not have the same safety structures in place as behavioral health units do; therefore, compensatory interventions must be put in place that protect patients while allowing ongoing medical treatment.

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Our medical center was experiencing an increase in the number of patients with suicide risk being placed on medical units. Consequently, there was also an increase in the number of patients who carried out self-harm actions.

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A team was gathered, which consisted of a clinical nurse specialist from a medical-surgical unit, nurse managers from inpatient psychiatry and medical-surgical units, and the nurse manager from the nursing resource office. Additional members included the psychiatry nurse liaison, 1 staff RN, and 2 patient care assistants. This team performed a comprehensive review of the medical center's current process for providing suicide precautions from varying points of patient entry to the medical center. A literature review was performed but yielded few recommendations.

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Interventions were developed to improve patient safety by addressing risk associated with the hospital environment, patient behaviors, and the knowledge and skill of the RNs and assistive personnel. Interventions included education of RNs and assistive personnel, modifying processes for patient placement, developing guidelines for managing the hospital physical environment, and developing tools for nurse-to-visitor communication and caregiver handoffs.

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Initial evaluation of the project was designed to measure compliance with project process changes. Ongoing compliance and evaluation of learning will be measured using a tracer team methodology. Evaluation of reduction in self-harm behaviors carried out will also be completed.

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Implications for Practice:

This CNS-led project will positively impact patient safety by changing organizational culture.

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Section Description

The 2010 National Association of Clinical Nurse Specialists (NACNS) Annual National Conference is planned for Portland, Oregon, on March 3 to 6. More than 375 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are expected to attend. This year's theme, "CNS as Internal Consultant: Influencing Local to Global Systems," demonstrates the breadth and depth of CNS practice and leadership at multiple levels in organizations and on healthcare.

A total of 142 abstracts were submitted for review, and 58 (not including student posters) were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session; student abstracts will appear in a later issue of the journal. The abstracts addressed CNS practice in all 3 practice domains as described in the Spheres of Influence Framework for CNS Practice. Abstracts emphasized patient safety and quality care outcomes, leadership, CNS education, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into the 3 Spheres of Influence, the role of the CNS in developing clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, the role of the CNS in National Database for Nursing Quality Indicators (NDNQI) activities, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNS's contribution to the well-being of individuals, families, and communities, as well as contributing to the advancement of the nursing profession.

The conference abstracts are published to share new knowledge with those unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics.

Watch for next year's call for abstracts and consider submitting for presentation at the next NACNS annual conference scheduled for March 9-12, 2011, in Baltimore, Maryland.

© 2010 Lippincott Williams & Wilkins, Inc.