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Quick Guide for Inpatient Management of Pediatric Patients Admitted with Suicide Attempt or Ideation

Quick Guide for Inpatient Management of Pediatric Patients Admitted with Suicide Attempt or Ideation - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Psychiatry, Related


Quick Guide for Inpatient Management of Pediatric Patients Admitted with
Suicide Attempt or Ideation
ADMISSION
Key
Points
Admitting Diagnosis:
Pediatric patients admitted for suicide attempt or suicidal ideation awaiting inpatient psychiatric placement.
Admitting Service/Unit:
1. If patient is 17 years or younger- Pediatric Hospitalist Service (P5 unit).
2. If patient is requiring critical care, admitted to the Pediatric Intensive Care Unit (PICU) under
the Pediatric Critical Care Service.
Safe
environment
and
personal
belongings
ξ 1:1 constant direct observation must be provided at all times when a patient is admitted under
suicide precautions. The Patient Safety Attendant (PSA)/Personal Safety Observer (PSO) may be
any RN or NA (family, relatives, friends MAY NOT substitute as a PSA/PSO).
ξ Attempt to assign patient to a room in close proximity to the nursing station.
ξ Patient’s door shall remain open unless medically necessary or if confidentiality dictates otherwise.
ξ Restrict personal property: place in hospital gown, remove sharps, strangulation risks (e.g., belts,
shoelaces, etc.)
ξ If concerned patient has self-injurious items in their possession, security may be called to search
patient’s belongings.
ξ Remove medical monitoring cords if appropriate (e.g., telephone, blood pressure, pulse oximeter)
PATIENT COMMUNICATION & EMERGENT BEHAVIORAL SITUATIONS
Key Points Avoid trigger words
Therapeutic
Communication
ξ Consistency is the key in caring for patients and their families. Compassionate care with the
firm adherence to the protocol in place is central to a smooth hospitalization.
ξ Start small, attempt to build a therapeutic and professional relationship with conversations.
ξ Remember that this is a difficult and sensitive time not only for the patient but for the family as
well.
ξ Every eight hours asses (and document) the patient’s suicide risk: “ Do you have suicidal
thoughts right now? What has changed since admission about those thoughts? How are you
coping with those thoughts right now? Is there anything we can do to help you feel safe?”
De-escalation
Strategies
ξ Have any people who are targets for the crisis behavior step out of the room.
ξ Keep as few staff as possible in the room, but keep enough to provide for safety.
ξ Do not engage in bargaining or argument. Remain objective.
ξ Use simple, declarative statements to tell the patient what to do with their body to stay safe.
ξ If there is agitation, consider calling Security right away. They are unlikely to put hands on the
patient but can be a calming “show of force” whose presence can remind the patient to be civil.
ξ Patients who have a PSA/PSO for suicidality are not safe to leave the hospital AMA. Notify
Security and CTL/STM, Nurse Manager, and Medical Team if patient attempts to leave
hospital.
ξ DO NOT use force to stop them. Security is to hold patient until the Primary Medical Team
determines disposition. The Attending team may consult with other services (I.E.-Psychiatry,
Legal, Risk Management etc.) to assist with this decision.
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2017CCKM@uwhealth.org


PATIENT ACTIVITY AND SUPERVISION
Key
Points
Patients with suicide attempt/ideation need
continuous supervision (e.g., Patient Safety
Attendant PSA) for safety, unless cleared by
Psychiatry.
Family members or friends should NOT be
permitted to substitute for staff providing
constant observation under any circumstances.
Activity
ξ The PSA/PSO should follow the list of expectations (outlined in a separate document).
ξ Patient may not leave the unit unless medically necessary: if they must go off the unit for procedures
they must be accompanied.
ξ Be aware of what family and friends bring into the room (i.e.: medications, items that can be used for
self-harm). PSA/PSO must inform the RN immediately if any harmful materials are discovered.
Bathroom
and
Shower
ξ The bathroom is a high risk area, DO NOT leave the patient alone.
ξ The bathroom door should be open at all times when the patient is using the bathroom or shower and
the PSA/PSO must be within arm’s reach of the patient for their safety. If uncomfortable watching the
patient while in the bathroom, please call additional staff for assistance.

DISCHARGE
Key Points
Patients will be discharged once they are medically stable and a safe discharge plan is in
place (i.e. inpatient psychiatric stay or home with a safety plan as deemed by the
psychiatrist.)
Necessary follow-up appointments should be scheduled prior to discharge.
If Going Home 1. Safety plan MUST be established by mental health clinician or MD on primary team
2. All patients should receive education (including crisis hotline number, local resources)
If Going to
inpatient care
1. Social Worker/Nurse Case Management will contact a referral facility on hospital day 1-2 to
arrange possible transfer
2. Social Worker/Nurse Case Management or Nursing will fax admission H&P and discharge
summary.









Reference the Suicide Screening, Assessment and Intervention Clinical Practice Guideline for additional information.
HEALTH CARE TEAM & COMMUNICATION
Key Points Multidisciplinary team will include representation from: resident team, attending hospitalist, nursing
staff, and social worker/case manager.
Communication
ξ Daily Family Centered Rounds will occur with the multi-disciplinary team to determine if
patient is medically stable.
ξ Psychiatrist Evaluation will determine patient placement upon discharge.
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2017CCKM@uwhealth.org