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COVID-19 and suicide risk: definitely two challenging patient care issues. Recently, The Joint Commission (TJC) answered a question about monitoring COVID-19 patients who are a high suicide risk. Specifically, the question was whether staff doing a 1:1 observation for a high suicide risk patient with COVID-19 (or suspected COVID-19) need to be in the patient’s room.

COVID-19: Suicide Risk Monitoring Procedures

In response to this question, TJC reiterated their current guidance re high risk patients in areas containing ligature and/or other safety risks. That guidance is that patients in those areas who are a high suicide risk must have 1:1 observation. (See the TJC FAQ Ligatures and/or Suicide Risk Reduction – Monitoring High-Risk Patients.) 1:1 observation means one qualified staff person to one high risk patient. That staff person must be able to immediately intervene if the patient attempts self-harm.

In addition, it’s important to note that a “qualified staff person” means a trained individual who has demonstrated competency. Also, the organization must document this training and competency assessment.

COVID-19: Suicide Risk & Infection Control

TJC noted that they do not prescribe the distance that the 1:1 observer should maintain from the patient. Rather, they leave that to the organization to define. However, they did state the observer must always have full, continuous view of the patient and be able to intervene if needed.

TJC also addressed the option of having the 1:1 observer positioned outside of the patient’s room. They indicated the observer must be able to do the following:

  • Maintain full, continuous view of the patient with the door closed.
  • Intervene without delay when necessary.

Since the observer would need to intervene without delay, that means the observer would need to maintain the appropriate Personal Protective Equipment (PPE) without causing a delay in entering the room. If that is not feasible, then the observer would need to remain in the room with the door closed and wear the appropriate PPE.

COVID-19: CDC Recommendations

TJC also referenced the current CDC recommendations for patients with COVID-19:

  • Patients with known or suspected COVID-19 should be in a single room with the door closed.
  • When entering the room of a patient with known/suspected COVID-19, staff should use Standard Precautions. They should also use a respirator or facemask, gown, gloves and eye protection.
  • The observer must complete training on how to properly don, doff, dispose of, and maintain PPE.
  • The observer should not be present in the room when aerosol generating procedures are performed unless they are wearing a respirator (rather than a surgical mask.)

TJC FAQ and Resources

For the exact wording of TJC’s response, see the FAQ Ligatures and/or Suicide Risk Reduction – Monitoring High Risk Patients With Known or Suspected COVID-19. TJC included this FAQ for both the Hospital and Behavioral Health Care manuals. Also, they listed it under both the National Patient Safety Goal chapter and the Infection Control chapter.

For additional TJC resources on suicide prevention and COVID-19, see the Suicide Prevention Portal and the Coronavirus (COVID-19) Guidance Portal on the TJC website.

Barrins & Associates Resources

For additional background on the NPSG 15 requirements for suicide risk reduction, see our recent posts:

When we conduct our Mock Surveys and Continuous Readiness Consultations, we do a deep dive on suicide risk . We always include a suicide risk tracer.  We also provide education on the revised 2019 requirements. And how to link suicide risk assessment to treatment planning.

We’ll continue to keep you posted on this important topic. And, most importantly, how you can ensure patient safety in your organization.