__________________________________ Keeping Clients Safe: Error and Safety in Behavioral Health Settings
Patient Safety: Behavioral Practice in Primary or Outpatient Care
Ultimately, when a patient is deemed to be at increased risk, immediate safety needs must be addressed and the best treat- ment setting must be provided, which may be admission to an inpatient unit. When leaving the care of the organization, the individual and family should be provided with prevention information and a comprehensive ongoing treatment plan. Preventative measures can include providing clients with the number of a crisis hotline, advising that weapons be removed from the home, and informing individuals and families that preventing access to large quantities and lethal doses of pre- scription medications reduces the risk of overdose death (Niederkrotenthaler et al., 2014).
Of course, a percentage of people commit suicide and are not receiving any type of ongoing care from a behavioral, medical, or inpatient psychiatric provider—simply put, they are in the community. Additionally, suicide rates are difficult to accurately gauge because of the impossibility of knowing the true intent of the victim. Despite this difficulty, reported suicide rates are at a 70-year high in the U.S. (Martínez-Alés et al., 2022). Interestingly, Ayer and colleagues (2022) have uncovered data that indicates that 80% of suicide victims have had contact with primary care, defined as family medi- cine, internal medicine, or women’s health, within one year of their suicide, and that 44% of suicide victims have had contact with primary care within one month of their suicide. This research points to the possibility of assessment and behavioral interventions within primary care settings that might stave off successful suicides. The inclusion of behavioral health professionals in primary care settings, or integrated care, has experienced tremendous growth in the past several decades. It is now more common to find on-staff internal behavioral providers in primary care set- tings, as well as advising behavioral professionals as contracted partners with group practices (Reamer, 2018). This represents a key event and a critical life-saving chance for behavioral providers and primary care providers to collaborate, assessing and treating patients who may be silently contemplating sui- cide. According to Ayer and colleagues (2022), education and training led by behavioral professionals can benefit primary care providers, who may not fully realize that they could be the final provider contact for a patient caught in the throes of suicidal ideation and planning. In outpatient care settings, safeguarding patients is complicated for providers. Frequently, suicidal clients do not report their intentions but have communicated them to significant others (Walby et al., 2018). Accordingly, in addition to asking patients directly, information should be obtained from family members, friends, primary care providers, and others who have been in contact with the patient. According to Ferguson and colleagues (2022), safety planning interventions, both in clinical practice and research, are gaining attention and positive momentum. According to the review, in-person safety plans written in a hard-copy format for the benefit of the patient are the most common, with Internet-based safety plans representing the minority of interventions. Accordingly, the review indicated safety plans are an effective intervention for reducing suicidal ideation and behavior, including decreasing marked symptoms of major depression. Moreover, the findings indicated that safety planning with patients also reduced the incidence of psychiatric hospitalization and demonstrated improved overall treatment attendance.
Self-Asessment Question
4. Ellen is a licensed mental health counselor who has been in private practice for more than 15 years. She conducts a new patient intake for a 54-year-old man who reports symptoms of major depression; however, he does not mention his suicidal ideation. Ellen probes more deeply into the symptom presentation, verifying the details of his depressive experience and verifying after a long discussion that her patient is currently suicidal, has a basic plan, and owns a handgun. He lives with his wife and has never had a suicide attempt before. The patient also mentions that he recently discussed his depressive symptoms with his primary care provider. After reviewing the local psychiatric hospitalization resources and admission steps, including the beginnings of a written safety plan, what is Ellen’s best course of action now? A) Wait until the next appointment and check on his symptoms B) Refer the patient to another provider who is male C) Obtain his authorization to speak with his wife and primary care provider, and discuss safety planning and coordinated treatment D) Force the patient to admit himself to a local psychiatric hospital Medication Errors in Psychiatric Hospitals Internationally, medications errors (MEs) and adverse drug events (ADEs) are understood to be critical public health issues that can harm patients who are hospitalized, including those in psychiatric hospitals. A systematic review of eight studies from the U.S., U.K., New Zealand, Australia, and Canada revealed that ADEs accounted for more than 15% of general hospital adverse events. Additional research revealed that the occurrence of prescribing errors (PEs), dispensing errors (DEs), and medication administration errors (MAEs) made up a median percentage of 7% of all medication dispensing transactions. Moreover, researchers have sought to understand the prevalence and nature of medication errors in psychiatric hospitals, where specific vulnerabilities of patients can create unique medication safety issues, concluding that medication
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