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Procedural Guidelines for the Care of Adult and Pediatric Suicidal Patients in the Emergency Department (ED)

Procedural Guidelines for the Care of Adult and Pediatric Suicidal Patients in the Emergency Department (ED) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Psychiatry, Related


Procedural Guidelines for the Care of Adult and Pediatric Suicidal Patients
in the Emergency Department (ED) at University Hospital (UH) and The
American Center (TAC)
Refer to the Suicide Screening, Assessment and Intervention Guideline for additional information.
Physician Intake/ Triage/ Waiting Room
Patients who present to the ED via self or family member with complaints of suicidal ideation or a
suicide attempt will be triaged when rooms are not immediately available. Upon completion of triage,
the triage nurse will enter a constant supervision order, selecting either 1:1 constant observation or
2:1 continuous visualization. Patients requiring 1:1 constant supervision are at greatest risk for self‐
harm (previous suicide attempt, presenting with suicide attempt). This order will become effective
when the patient is roomed in the ED. The placement of the order will trigger a page to the ED Care
Team Leader (CTL)/ charge nurse alerting him/ her of the need for a sitter once the patient is roomed.
The ED CTL/ charge nurse will send a Jabber message to the Nursing Coordinator, alerting him/ her of
the sitter need.
Belongings will be placed in the locked cabinet in the UH ED waiting room until the patient can be
roomed. Belongings will be placed in a locked cabinet at TAC ED. If the patient refuses to provide his/
her belongings, Security will be contacted to assist with persuading the patient. Security may wand
the patient’s belongings at this time. The patient will not be placed in a gown until roomed.
The triage nurse will alert the Security officer or police officer in the waiting room verbally that the
patient needs to be watched until roomed. The patient should be placed near the Security/ police
officer podium or desk.
Rooming
Once roomed, all patients will be placed in a no‐tie gown. Rooms will be prepared for patient
placement prior to the patient being roomed.
Rooms 10‐12 UH ED or Room 45 TAC ED
*All items will be moved to the head of the bed, locked in the sink closet or removed from the
room.
*The sink door will be closed.
*The call light will be unplugged and placed in the basket at the head of the bed (HOB).
*The garage door will be closed.
*The only item that should be remaining in the room, outside the garage door, is the
stretcher.
Other ED Rooms
*If the patient is 2:1 continuous visualization, the patient should be placed in the one of the
following beds.
‐39 or hallway 39 (UH)
‐34 or 35 or hallway 34 (UH)
‐15 or hallway 15 (UH)
‐43 and 44 or 47 and 48 (TAC ED)
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2017CCKM@uwhealth.org

These rooms were paired because they allow one sitter to continuously visualize two patients. If the
patient does not require monitoring, all cords/ cables should be removed prior to the patient being
roomed (e.g., call light, ECG, pulse ox. . .).

Monitoring
If a patient does require physiologic monitoring, the following precautions will be taken.

Room set up
*The door/ curtain will remain open at all times.
*The lights will remain on at all times, but may be dimmed.
*Any unnecessary cords will be removed.

Expectations of Patient Safety Attendants/Personal Safety Observers
Whether the patient is a 1:1 constant observation or a 2:1 continuous visualization, the
PSA/PSO must keep the patient(s) in view at all times. If the PSA/PSO must respond to one
patient, leaving the other unobserved, the PSA/PSO will first call for help. Any staff member
may respond (RN, EDT, EDC, physician. . .) for a short period of time to watch the second
patient. See PSO/PSA handout of expectations.


Disposition
Patients being admitted to UH or American Family Children’s Hospital will have a belongings list
completed and will have their belongings searched and wanded by Security. Patients being transferred
from TAC ED to UH ED or UH inpatient will have their belongings searched and wanded by Security
prior to transfer. Patients being discharged will have their belongings returned to them. Patients being
transferred to another facility will have their belongings turned over to the transporting entity.

For more information, refer to UW Health Policy 2.1.22- Patient Belongings and Valuables.


Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2017CCKM@uwhealth.org