Increasing the Compliance of Suicidal and Homicidal Ideation Assessment in the Emergency Center
Dorothy Alford, MSN, BSMT, RN, CEN, firstname.lastname@example.org
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Purpose: National Patient Safety Goal 15 A focuses on identification of individuals at risk for suicide and aims to increase use of a screening assessment tool to identify risks of suicide and/or homicide. The compliance rate for initial assessment of suicide risk during triage in an adult emergency center (EC) at a large hospital in the Southwest was 84% in the last quarter of 2009. When screening was performed, primary nurses were not conducting more in-depth assessments for patients who screened positive for suicidal and homicidal ideation. Regulatory standards require rates of 90% or more for initial risk assessment as well as more in-depth assessment of patients who screen positive for risks. The purpose of this project was to improve initial screening rates and to meet standards of practice for more detailed assessment of patients identified at risk for suicide or homicide.
Design: A quality improvement project was conducted. Daily medical record reviews were performed on all charts of patients seen in EC triage. Data were gathered from the electronic medical record. Open record reviews were conducted for all patients who screened positive on initial assessment of suicidal and homicidal ideation to evaluate compliance with in-depth assessment of suicide risk. Coaching was provided for registered nurses who were non-compliant.
Setting: The project was implemented at the Adult Emergency Center of a large county hospital system in the Southwest. The county hospital is a level one trauma center located in the Texas Medical Center of Houston Texas.
Participants: Documentation by registered nurses in medical records of all patients seen in emergency center triage was reviewed.
Methods: Education was provided for the emergency center staff with emphasis on the National Patient Safety Goal standard 15A, the hospital policy for Suicide Risk Assessment and the instrument used for Assessment of Risk Factors. Continuous chart reviews were performed to evaluate nurses’ compliance with the safety standard. Open medical records review provided opportunities for just-in-time education for registered nurses who were not meeting the practice standard.
Results: After providing education, reviewing medical records, and providing individual coaching the compliance rate increased from 84% to 94% for the initial risk assessment at triage. In-depth assessments of suicide risk were performed by primary nurses at a 95% rate.
Implications: Using the quality improvement process to evaluate compliance with regulatory standards supports identification of educational needs, intervention with process barriers, and implementation of appropriate measures to assure patient safety.
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