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Risk management for healthcare entities: Self-harm and suicide prevention

To help prevent instances of self-harm and suicide across their organization, healthcare entities will need to include a self-harm and suicide prevention strategy as a part of their broader risk management plan. Equipped with a holistic approach, healthcare entities are better positioned to support the needs of at-risk groups, deliver quality care, and provide a safe patient environment.

Healthcare entities have an ethical and legal responsibility to maintain the safety and wellbeing of patients under their care. As part of their commitment to ensuring patient safety, healthcare entities need to pay particular attention to identifying patients at risk of self-harm or suicide and implementing measures to protect them.

The following guidance highlights key risk controls healthcare entities may implement to align their organization and strengthen their approach to self-harm and suicide prevention. It is not an exhaustive list and should be used in conjunction with internal policies and procedures, as well as in compliance with local laws and regulations.

Code of conduct

Amending your code of conduct to include best practices, policies, and procedures for self-harm and suicide prevention is essential to align members of your organization on your approach. It should reinforce the importance of self-harm and suicide prevention as part of maintaining patient safety and provide specific guidance on how healthcare teams can do so.

Develop and review, at least annually, a comprehensive suite of policies and procedures that address:
- Commitment to self-harm and suicide prevention to ensure patient safety
- Establishment of where relevant policies and procedures are enforced
- Expected accountability of all parties, including:
  - Employees
  - Independent practitioners (For example, physicians and midwives)
  - Students
Articulate safety measures as part of the suicide prevention strategy
Ensure that training regarding the policies is mandatory for all individuals and groups
Ensure the policies are accessible to all individuals and groups

General guidance

When patients are admitted to the emergency room, inpatient units, or outpatient clinics, the following actions and/or measures should be taken by members of the healthcare team to ensure the safety of patients, where applicable:

Upon arrival, review the following to determine if the patient is at-risk for self-harm and suicide:
- Presenting condition
- Health history
If the patient is a transfer, be sure to confer with the transferring staff to have the most comprehensive assessment of the patient’s condition
If the patient is deemed at risk for self-harm and suicide, consider undertaking the following precautions:
- Conduct a visual inspection of the room or treatment area:
  - Prior to patient admission or transfer to the room
  - Upon the start/end of each shift
- Provide patient with gown that has no strings or drawstrings
- Place the patient in a room or treatment area, which provides optimal safety measures to prevent self-harm and suicide, which may include a blend of the following:
  - Do not leave patient unattended behind a closed curtain or door
  - Be sure to note in the patient’s chart that patient is at risk for self harm, as well as the actions that have been taken.
Lock cabinets
Remove in-room sharps container or ensure sharps container is locked and secure
- Remove all sharp objects (For example, needles, scalpels, knives, scissors, nail files, or glass items)
- For patients needing to be admitted overnight, take the following precautions:
- Remove all detachable items unless medically necessary, such as:
  - Electric cords, telephone cords, and bed cords
  - Window/blind cords
  - Oxygen tubing/flowmeter
  - Monitoring equipment (For example, ECG cables)
  - Excessive medical tubing (For example, oxygen tubes and IV tubes)
  - Suction tubing
  - Nurse call light in room and bathroom (If removable)
- Remove other potentially harmful objects in the room or bathroom, including:
  - Shower curtains
  - Shower heads
  - Hanging curtains
  - Door locks
- Remove plastic trash bag liners, linen containers, and plastic bags
- Remove extra linens (For example, bed sheets, towels, and pillowcases)
- Inspect patient belongings and remove any potentially harmful objects, including:
  - Patient medications
  - Glass or sharp items
  - Toiletry items containing alcohol
  - Matches and lighters
  - Belts, straps, ties, and shoelaces
- If potentially harmful objects are found, store them while patient is admitted, and return upon discharge
- Enforce that visitors do not bring bags into the room and secure visitor belongings during visit with patient at reception or security desk
- Reassess room for safety after visitor leaves
- Utilize disposable cups, plates, and blunt utensils during meals. Count before and after meals and ensure proper disposal
If the patient is being transferred or admitted, staff are responsible for conveying critical information to the following staff as part of the transfer of care:
- Security staff
- Patient transport staff (For example, porter)
- Community resources/follow-up (e.g. family physician, social worker, community support).
- Receiving staff
If patient is being discharged, staff should leverage the following measures to facilitate the exchange of critical information during transition of care:
Referral protocols
Interagency agreements
Rapid referrals

Training

It is essential that members of the healthcare team caring for patients at-risk for self-harm and suicide participate in a comprehensive and standardized training to raise awareness on self-harm and suicide prevention and safety. All training development, review, and updates should be in alignment with organizational, professional, and ethical standards:

Develop a role-based training program that enhances awareness and understanding on self-harm and suicide prevention, including safety measures as part of the broader self-harm and suicide prevention strategy. Specifically, the training should address the following:
- Identifying and supporting at-risk patients
- Integrating care plans and treatment
- Streamlining transitions of care
- Accessing community services and resources
- Building life skills and resilience
Communicate the consequences of non-compliance with policies and procedures
Define the processes for reporting and responding to patient safety incidents
Establish a training schedule, which requires the following parties complete onboarding and regular refresher training:
- Employees
- Independent practitioners
- Students

Summary

As healthcare entities continue to focus on delivering safe and quality healthcare services, they have a responsibility to evaluate at-risk patients and prevent instances of self-harm and suicide. To do so, they need to align their organization on the importance of self-harm and suicide prevention and strengthen their holistic prevention efforts to better mitigate this complex risk and improve patient outcomes.

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