Standardizing screening for risk for suicide in a pediatric emergency department
Fran J. Damian, MS, RN, NEA-BC; Jennifer Cummings, MSW, LICSW
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Session C presented Monday, September 30, 1:00-2:00 pm
Purpose: Suicide in children ages 10-18 is the second leading cause of death in the United States (Centers for Disease Control, 2016). Research on teens who have attempted suicide, or the cause of death was suicide, shows that many of these adolescents had a recent visit for medical care. Because of the critical impact of early intervention, the Joint Commission and the Centers for Medicaid and Medicare Services worked to develop recommendations for suicide prevention including early screening. The pediatric emergency department presents a unique opportunity to identify children who experience suicidal thoughts, and to intervene with a safety plan. The purpose of this Quality Improvement project was to develop a standardized pediatric suicide screening process.
Design: This was a quality improvement project using Plan Do Study Act methodology to standardize the suicide screening process. This project focused on adolescent patients to allow the team to understand feasibility, acceptability to parents and patients, as well as the impact on the ED workflow.
Setting: Academic, urban, level 1 pediatric trauma center.
Participants/Subjects: Nursing and Emergency Psychiatry Service (EPS) staff.
Methods: A multidisciplinary committee was formed to explore best practices in suicide prevention in the pediatric ED, and recommend standardized practice. The ED and EPS leadership teams partnered with a specialist in suicide prevention from the NIH to conduct educational sessions with the nursing, physician and EPS staff. The Ask Suicide Questions (ASQ), a 5-question validated tool was selected for use by the ED nurses when conducting an initial assessment on patients 12 and older presenting to the ED with a medical or surgical problem. A referral is made to the EPS when there is a positive response. When a patient screens positive for having active suicidal thoughts, the institution's behavioral health evidence-based guideline is initiated. After the initial phase of implementation, the specialist returned to meet with the nursing and EPS staff to learn about barriers and reinforce important aspects of using the screening tool. Barriers included concern for asking the questions related to suicidal ideation to a young appearing child, worry about parent response, and disagreement with screening. Case studies and current events involving teens with suicidal ideation were important in validating our staff's belief that screening in an ED was an important intervention to linking our patients to necessary resources.
Results/Outcomes: The percent of eligible patients screened increased gradually the first year. Review of the data and follow-up with nurses who were not screening was done. The rate of patients screening positive has consistently been 2%, but now trending up to 6% . No patients who screened positive required an admission for imminent safety concerns.
Implications: Screening for risk for suicide in an ED setting is effective for early detection and intervention; engaging families in suicide prevention strategies is also critical. The support of Senior Leadership, the identification of stakeholders, and listening to the voices of the ED caregivers to understand the impact that this project could have on workflow and practice were all critical to the success of this project.
Pediatric Emergency Department
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