Suicide Prevention Pathway Behavioral Health Service Line Dr

Suicide Prevention Pathway Behavioral Health Service Line Dr. Linda Lang Chair Department Psychiatry

Why Screen Every Patient? th 10 Leading cause of death in the US. The Delaware suicide rate outpaced the National average from 2000 -2014 Risk of suicide attempt or death is highest within 30 days of discharge from an ED or inpatient psychiatric unit 37% Of people who died by suicide having visited an ED within a year of death, did not have a mental health or chemical dependency diagnosis 45% of individuals who die by suicide were seen by their PCP within 1 month of death. 70% of patients leaving ED after a suicide attempt never attend their first outpatient appointment

Why Screen Every Patient? CCHS Initial Assessments Inpatient n=210 ED n=2, 524 Location of Initial Positive Screen For Inpatients, Every 3 Days a New Patient Initially Indicates Risk 100, 000 80, 000 Christiana ED 60, 000 40, 000 Wilmington ED Middletow n ED All EDs have Patients Indicating Risk 20, 000 0 Total Screens Positive 2. 6% of Patient’s Indicate Risk (Oct. 2016 – Mar. 2017)

The Tool: Columbia-Suicide Severity Rating Scale (C-SSRS) • Who: Most CCHS patient encounters • When: At triage (ED) or admission (inpatient) • Performed by: RN • Nationally recognized, validated screening tool • Provides 3 Levels of Risk

The Tool: Columbia-Suicide Severity Rating Scale (C-SSRS) Low Suicidal ideation – no intent or plan or recent self-directed injurious behavior Moderate Suicidal ideation – with method or injurious behavior within 1 -12 months, but no intent or plan High Suicidal ideation – with intent or plan or injurious behavior within 1 month.

Pathway Suggestions for Care 3 levels of stratified risk to facilitate appropriate and standardized interventions Low Risk Moderate Risk High Risk Patient is safe for outpatient treatment Patient may not be safe for discharge Patient is not safe for discharge Provide patient/family education including Safety Planning and outpatient referrals; Communication Order will detail these items in Exit. Care Psychiatric Emergency Services (ED patients) should perform more detailed screen to determine level of risk Safety Companion, Psychiatric Consult, Precautions automatically ordered by pathway Safety Companion and Psychiatric Consult not indicated Consider Safety Companion, Precautions, Psych Consult

What is Your Responsibility?

The Pathway in Powerchart Pathway Indicator in the Physician’s Note

The Pathway in Powerchart Pathway Indicator on Problem List

The Pathway in Powerchart Suicide Screening in Form Browser (sorted by “Form”) *Columbia-Suicide Severity Rating Scale comes in several different versions, including the Daily/Shift Screen seen here.

The Pathway in Powerchart Suicide Risk Order as it appears in Order List *Can appear as High, Moderate, or Low Risk Suggested Patient Education appears as a Communicate to Nurse order

For more information contact. . . Dr. Linda Lang, Chair of Department of Psychiatry LLang@Christiana. Care. org 320 -2962 Psychiatric Consult Line 733 -4225 Suicide Prevention Pathway Document (under Behavioral Health) http: //pathways. christianacare. org/