Let's Talk about Suicide

Non-visit care interactions with patients and caregivers continue to be on the rise as care models are evolving and care delivery system and healthcare landscapes continue to change. Ambulatory nurses provide care over the telephone or through an online patient portal on a regular basis. Nurses are often the first and only contact with the suicidal patient. Nurses may receive messages from suicidal patients and do not have the resources to respond appropriately to this low volume high risk episode.

Objectives:
1. Outline a standardized process for assessing and responding to a suicidal caller on the telephone.
2. Identify methods used to involve the interdisciplinary team in the process and training nursing staff for suicide encounters.

Methods: A work group of ambulatory nurse leaders, including telehealth experts, met with key stakeholders across the large enterprise: integrated behavioral health, telephone operations, legal, security representatives, local law enforcement, and social workers. The team reviewed current documents used in primary care, the institutional telephone triage guidelines, as well as assessed current educational offerings available in the department of nursing.

An algorithm and script were created to assist nurses in communicating and expediting care of suicidal patient callers over the telephone. The nurses were educated on use of the Columbia Suicide Severity Rating Scale and best practices based on identified level of risk. This standardized process was piloted in three subspecialty clinics.

Results: Pilot results will be available by spring of 2019.

Conclusions: Nurses are pivotal communicators in patient safety and identifying appropriate resources especially in non-visit encounters. Given the current healthcare climate, this situation may become more frequent. This process using best practices can be replicated across the enterprise and tailored based on availability of local resources.