- Question: Should screening for suicidality be documented for all patients or only if certain criteria are met?
- Question: What is the best evidence-based suicide screening tool for pediatric patients?
On December 6, 2018 The Greeley Company held its annual “Survey Hot Spots” national webinar. Feel free to view our free “Hot Spots” webinar in case you missed the live session.
Among the questions raised during the webinar were two related to a recent “hot spot” challenging hospitals, critical access hospitals and psychiatric hospitals across the country: suicide prevention.
The attendee’s questions about suicide prevention and our responses are below.
Question: Should screening for suicidality be documented for all patients or only if certain criteria are met?
- Answer: Only if certain criteria are met …
The requirement to perform an evidence-based screening for suicidality in hospitals applies only to “patients in psychiatric hospitals and patients being evaluated or treated for behavioral health conditions as their primary reason for care in general hospitals.” (An evidence-based screening is also required in the Joint Commission’s Behavioral Health standards, which applies to behavioral health care outside of a hospital.)
This has been the requirement for the last several years. A myth nevertheless persists within the industry that all patients must undergo evidence-based suicide screening (e.g. the Colombia Suicide Risk Assessment Scale or the less-well-evidenced “SAD Persons” scale).
Greeley ’s premium online learning session, ‘Identifying and Protecting Patients at Risk for Suicide’ outlines in detail such screening within the inpatient population is neither required nor recommended. There are times when an evidence-based screening tool might be helpful in the general (non-psychiatric) ambulatory setting, such as oncology clinics. However, this screening is not required by the Joint Commission.
That is not to say that a patient’s psycho-social status should not be part of every hospital patient nursing and/or medical assessment/evaluation. Our online learning opportunity will walk you through a common sense approach to screening, assessment and protecting patients whose general psycho-social assessment indicates the need for further evaluation and precautions. It will include edit-ready model tools customized for four different types of institutions: psychiatric hospitals, general hospitals with an emergency department and inpatient behavioral health units, general hospitals with an emergency department but without an inpatient behavioral health unit, and general hospitals with neither an ED nor a BH unit. The tools, tweaked to match the type of institution, include: a model policy and procedure, assessment-based levels of observation, screening questions and decision tree, required elements of the full suicide risk assessment, an environmental risk assessment tool for the general (non-behavioral health) unit, a “room sweep” tool to be used when patients at high risk for suicide are housed in a general inpatient room.
A separate session, Suicide Ligature Risk Assessment and Mitigation, covers the process for meeting the ligature-resistant requirements for inpatient behavioral health units and behavioral health emergency departments/units.
Question: What is the best evidence-based suicide screening tool for pediatric patients?
- Answer: The Greeley Company does not represent itself as a behavioral health provider or an expert in clinical matters. However, most experts seem to be comfortable with the accuracy of the Columbia-Suicide Severity Rating Scale (C-SSRS) as a screening tool. The Columbia Lighthouse Project has developed tools for three populations: Adults & Adolescents, Individuals with Cognitive Impairments, and Young Children. We will leave it to behavioral health clinicians to opine about the clinical efficacy of these tools.
From a compliance standpoint (our area of expertise), the C-SSRS would certainly comply with the requirement for suicide screening of individuals being treated for a behavioral health condition.
Remember, however, that a comprehensive suicide risk assessment is required for positive screens on the C-SSRS or equivalent tool. NPSG 15 establishes the required elements of this risk assessment.
Our upcoming educational event (January 6, repeated January 8) will provide the attendees with a variety of screening and assessment tools and guidelines for associated precautions.
The Greeley Company team looks forward to helping you solve these difficult problems in the months and years to come. For more information about how Greeley can help accelerate solving your challenges with practical solutions, you may contact us at 1.888.749.3054, email us at firstname.lastname@example.org or complete the form below to start the conversation.