individual state licensing board requirements for continuing education on medical error. Correct identification of clients is one of the Joint Commission’s 2014 Behavioral Health Care National Patient Safety Goals (The Joint Commission, 2014). Based on the rationale that misidentification can occur at any stage of diagnosis and treatment, this goal is intended for behavioral health settings where high-risk medications such as methadone are administered, and its aim is to reliably identify the correct individual for whom a particular service or treatment is intended. At least two identifiers are required. Acceptable identifiers include the patient’s name; assigned identification number; telephone number; or another type of person-specific identifier, such as birth date. In behavioral health settings with populations that are less in flux, such as group homes or individual therapy, visual recognition is an acceptable identifier. Psychiatric Hospitalization: Improving Assessment of Suicide Risk Hospitalized psychiatric patients who commit suicide are the most frequently reported sentinel event in behavioral health settings (reference). Paradoxically, suicidal risk can be misunderstood by behavioral health workers, who may lack in- depth training on successfully handling these types of patient risks. Some frontline staff report feelings of anxiety related to patients who are actively suicidal, and they also experience anxious concerns for their own safety. Naturally there is stress in being a healthcare worker responsible for the safety of patients with this type of issue (Morrissey & Higgins, 2018). Identifying individuals at risk for suicide is one of The Joint Commission’s 2014 Behavioral Health Care National Patient Safety Goals. Its purpose is to identify individuals who are at risk for suicide both during the time they are receiving treatment from a healthcare organization and following discharge. The 2014 goal requires conducting a risk assessment that identifies specific characteristics of the individual served (risk factors) and environmental conditions, such as the quality of social support and access to lethal weapons, that increase or decrease that risk (The Joint Commission, 2014). Interestingly, Large and colleagues (2018) sought to understand the clinical viability of certain assessment measures used on inpatient psychiatric units. Their meta-analysis uncovered several caveats for clinical practice. The first cautionary point issued by the research group was to realize that the classification of patients by high risk of suicide and low risk of suicide can be clinically deceptive. Researchers found that almost half of inpatient suicides occurred within groups that were clinically considered low risk, cautioning that clinicians must realize that certain assessment classifications will provide a false sense of security in preventing patient suicide. Moreover, their research uncovered that a significant number of high-risk patients will not go on to commit suicide. This caveat from the research team emphasized the importance of tempering the use of intrusive coercive interventions within this patient group. Overall, the study emphasized the limited reliability of standard assessments and rote interventions to effectively predict or prevent patient suicide. Rather, Large and colleagues (2018) a thorough and sympathetic assessment of the patient’s individual circumstances and current treatment needs should always form the basis of an inpatient treatment plan” (p. 1126). Patient Safety: Behavioral Practice in Primary or Outpatient Care 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 medicine, 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 settings, 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 suicide. 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. Ultimately, when a patient is deemed to be at increased risk, immediate safety needs must be addressed and the best treatment 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 prescription medications reduces the risk of overdose death (Niederkrotenthaler et al., 2014).
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