Preventing Inpatient Suicide

Inpatient suicides are viewed as the most avoidable and preventable because they occur in close proximity to staff. Early in the admission is a clear high-risk period, but risk declines more slowly for some patients. Included here are factors that may guide the clinician in treating these at-risk patients.

TIPSHEET: INPATIENT SUICIDE PREVENTION RECOMMENDATIONS

•More stringent assessment of risk
•More stringent monitoring of patients’ risk
•Better monitoring of behavioral signs and symptoms
•Improve staff communication of signs and risk
•Wait for significant, stable, reliable change before relaxing precautions
•Improve suboptimal staff-patient relationships
•Gather collateral information
•Do not rely solely on patient self-report of no suicidal ideation
•Do not rely on “no suicide” contracts
•Ensure a safe physical environment that is devoid of means to commit suicide, access to hidden areas. Units should be periodically checked to ensure suicide-proof architecture
•Avoid overconfidence in or overreliance on 15-minute checks
•Avoid premature discharge
•Smooth, tight transition to outpatient care
•Base suicide precautions on an adequate risk assessment and clinical rationale
•Document risk assessment and clinical rationale
•Form a suicide prevention committee
•Utilize Failure Mode and Effect Analysis

For more on this topic, see "Inpatient Suicide: Identifying Vulnerability in the Hospital Setting," by James L. Knoll, IV, MD, from which this Tipsheet is adapted.