Implementing a suicidal ideation response program to help at-risk adults

Author: Jill Clenning

Vanderbilt Health Adult Outpatient Clinics has developed a new suicidal ideation response plan that will provide clinicians and staff with additional resources to provide appropriate care to patients identified as having suicidal thoughts or planning to commit suicide.

On December 13, adult non-psychiatric outpatient clinics will begin following a new plan for the screening, intervention, and appropriate care of outpatients 18 years of age and older who express suicidal ideation (SI) or other related thoughts or thoughts standard response. Actions taken during an outpatient appointment, via phone call, virtual message, or telemedicine visit. There are separate policies for patients expressing SI in the inpatient setting.

The effort started with two nurses, Neurology Clinic Manager Jill Shelton, RN, and Nursing Coordinator Jessica Stroh, RN, said Vice President of Adult Ambulatory Care and Chief Nursing Officer. As they seek to support their teams and patients when faced with this crisis situation. Michele Hasselblad, DNP, RN, NE-BC. We understand that many other clinicians and staff are facing similar challenges, so we have built on our initial work to develop a policy and a set of tools that can be used across our clinics to provide a consistent response. This program represents an exceptional collaboration across disciplines and entities to make a difference for our teams and communities.

According to CDC statistics, more than half of the people who die by suicide each year have no known mental health condition. Suicide remains one of the leading causes of death in the United States. In 2021, 12.3 million adults seriously considered suicide, 3.5 million adults made a suicide plan, and 1.7 million adults attempted suicide, according to the Substance Abuse and Mental Health Services Administration.

“We can do our part to save lives by screening, intervening and caring for people who may be considering or planning suicide,” said Tiercy Fortenberry, MSN, RN, CPPS, vice president of quality, safety and risk prevention. The Suicidal Ideation Response Plan and related policies provide clear steps for clinicians on how to mediate for those identified as being at risk.

A suicidal ideation tool that supports completing these steps has been added and can be easily accessed eStar, and provide role-specific SI training to clinicians and staff in learning exchanges. Training will also be provided for VUPD officers who may need to assist at-risk populations. The effort is all about saving lives, she said.

The Colombian Suicide Severity Rating Scale is a screening tool for eStar. Patients are asked a series of simple, direct questions about suicidal thoughts and behaviors to help determine whether they are at risk for suicide. This tool helps determine the severity and urgency of risks and determine the level of support needed for personnel.

Add intervention resources eStars will help employees. A key resource is the Stanley-Brown Safety Plan, an evidence-based intervention designed to help people experiencing self-harm and suicidal thoughts identify actions to take to reduce suicide risk and improve safety. All individuals identified as being at higher risk will complete an individualized Stanley-Brown Safety Plan with support from staff. The plan clarifies warning signs, outlines internal and external response strategies, and provides additional support resources.

Storyboard notice eStar will provide patients with their latest Columbia Suicide Severity Rating Scale score and safety plan from the past six months.

Rates of depression and anxiety are increasing, said Stacy Stark, PhD, MS, RN, chief quality and patient safety advisor for behavioral health. Our staff need to be equipped to identify and respond to patients who trust us to provide the care and resources they need, including support for their mental health, regardless of care setting. This response policy provides staff with a standard approach to addressing suicidal ideation, using a suite of evidence-based tools and resources to support patients when they need us most and to give our staff the confidence and knowledge to respond safely .

Once the suicidal ideation response plan is implemented, a team hotline will be available for the first three days to provide clinical support. Clinicians can also ask questions using the VNIS dynamic inbox: nursinginformatics.amb@vumc.org.

Hasselblad said patients and families are our first priority. Adult outpatient clinics are an important point of contact for those we serve, and our new Suicidal Ideation Response Plan and related policies are important tools to guide the care of those who may be considering or planning suicide. Through these tools, we can better educate patients and their families, provide important resources, and intervene appropriately. Most importantly, we will save lives.

Over the past 18 months, a team has worked on the policy, its implementation and training. Team members and executive sponsors include: Sydney Bush-Foster, MSN, RN, Jenna Cabler, MS, Nathaniel Clark, MD, Shawn Coomer, MBA, MSN, RN, Melanie Cruz-Khalili, Suzanne Duckworth, Caroline Epps, Annette Eskew, Jenelle Grewell, MSN, RN, Fortenberry, Amy Hampton, JD, and VUMC Office of Legal Affairs, Terri Hartman, MSN, RN, Hasselblad, Jill Jones, MD, Diane Moat, JD, RN, Julia Morris, BSM, MSN, JD, Allison Murphy, MD, David Posch, MS, VUPD Capt. Mike Pring, Jill Shelton, RN, Jenny Slayton, DNP, RN, Stark, Jessica Stroh, RN, Ashley Trambley, MSN, RN, Colin Walsh, MD, and Patty Lai Special, MD.

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