8 Inpatient SuicideA total of 27 suicidal patients were identified by the adverse event reports during hospitalization from 1995 to 2004.The SMR of inpatient suicide was 8.25 (95% CI = ).Hospital suicide rates were in age categories of 25-29, 30-34, 40-44, and yearsTseng M-CM, Cheng IC, Hu F-CJ Formos Med Assoc 2011, 110(4):
9 Sentinel Event Statistics Type of Sentinel Event#%Wrong-site surgery86713.5%Suicide77012.0%Op/post-op complication71011.0%Delay in treatment5368.3%Medication error5268.2%Patient fall4066.3%Unintended retention of foreign body3094.8%Assault/rape/homicide2453.8%Perinatal death/loss of function2013.1%Patient death/injury in restraints198Date: 2010/03/04
10 Report from the Accreditation Committee of the Joint Commission's Board of Commissioners In General Hospitals Many of the Inpatient Suicides Occurred in Psychiatric UnitDate: 2010/03/04
23 Medical Condition and Increased Suicide Risk IllnessIncreased Risk (X)HIV and AIDS6.6Huntington’s disease2.9Malignant neoplasmAll sites1.8Head and neck11.4Multiple sclerosis2.4Peptic ulcer2.1Chronic renal failureDialysis14.5Transplantation3.8Spinal cord injurySystemic lupus erythromatosis4.3Douglas G. Jacobs ed. The Harvard Medical School Guide to Suicide Assessment and Intervention. Jossey-Bass, 1999.
24 Cheng IC et al., General Hospital Psychiatry 31 (2009) 110–115. Inpatient suicide in a general hospitalCheng IC et al., General Hospital Psychiatry 31 (2009) 110–115.
35 SOP and structured checklist of dangerous goods Suicide Risk AssessmentNo riskGrade 1Security check everydayLow riskGrade 2Security check Three times a dayModerate riskGrade 3High riskGrade 4Security and general check every 15 minAdd structured items in routine nursing record for emotion and behaviors observationWard routine: check general condition of patient every 30 minutesIf abrupt emotional reaction or disrupted relationship with significant others is checkedsecurity check every weekGrade 2, 3Ultra high riskSecurity and general condition check every 15 minBefore RCAAfter RCA
48 Indications for Psycho-social Referral Physician is uncertain about psychiatric diagnosisPatient has a history of major psychiatric disorderPatient is suicidalPatient is requesting assisted suicide or euthanasiaPatient is psychotic or confusedPatient is unresponsive to therapy of first line antidepressantPatient’s family is dysfunctional