During surveys of inpatient psychiatric units (and sometimes in residential programs) TJC surveyors continue to cite suicide risks they identify in the environment. Commonly occurring issues are plastic trash can liners, loopable hardware in bedrooms and bathrooms, and non-breakaway fixtures in closets and showers. When these risks are identified, the surveyor typically asks if the organization has conducted a risk assessment on the issue. All too often, the organization is unable to demonstrate (and document) that they have conducted a formal risk assessment and then analyzed the results to make an informed decision about how to address the identified risk.
One of the most high risk locations for suicide attempts is patient bathrooms. In psychiatric hospitals, the most frequent method of suicide is hanging. It is estimated that 75% of inpatient suicides occur in the patient’s bathroom, bedroom, or closet. Many psychiatric units have already taken steps to eliminate hanging and self-harm risks in patient bathrooms. Others have made the decision not to eliminate these risks because they feel that they have sufficient mitigating features in place.
If you are in the process of assessing risks in patient bathrooms in your setting, you may find the Suicide Risk Assessment Tool for Inpatient Bathrooms useful. It provides a format for determining if key best practice environmental features are in place to help minimize the risk of suicide in the bathroom. A critical component of the tool is that once a risk is identified and rated, there is an outline for documenting your evaluation of that risk, your conclusions, and your course of action.
For additional information on the topic of risk assessment, see our May 2013 newsletter article Conducting and Documenting Risk Assessments. Another useful tool for conducting a unit-wide risk assessment is the ECRI Institute Healthcare Risk Control Self Assessment Questionnaire.