Discussion of data at a national level and its application to the organization.
Exploration of risk factors, warning signs, protective factors, and glossary of terms related to suicide ideation and behaviors.
Reflection on personal clinical experience when dealing with individuals experiencing suicide ideation or suicidal behavior.
Emphasis on self-awareness, comfort level, and confidence as guides for effective suicide risk assessments and screening.
Terminology and Language
SI: Refers to Suicide Ideation.
SB: Stands for Suicidal Behavior.
Distinction between active SI and passive SI, indicating levels of planning or thoughts about ending one’s life.
Language and Perspective
Preferred terminology includes death by suicide rather than phrases like committed suicide or successful suicide.
This language shift aims to promote a clearer understanding and view of suicide as a patient safety issue, rather than a moral failing.
Importance of understanding concepts like death contemplation and death anticipation within the hospice context.
Clinical Practices in Hospice
Hospice practitioners hold a unique responsibility in addressing suicide ideation and intrusive thoughts within terminally ill patients.
Key themes explored in hospice care include:
Intent: Understanding the motivation behind suicidal thoughts.
Methods: Differentiating between various methods of suicide.
Specificity: Assessing the specificity of a patient's suicide plan.
Emotional Responses and Self-Care
Importance of reflecting on personal feelings, triggers, and emotional responses when working with patients experiencing suicidal thoughts.
Recognizing the emotional energy required to engage with complex cases, emphasizing the need for self-tenderness.
Patient Safety Issues in Hospice
Acknowledgment of suicide as a significant concern in hospice, impacting both patients and their families.
Discussion of the Joint Commission’s 2019 sentinel alert regarding the increased risk of suicidality in hospice patients who have recently engaged with healthcare systems.
Statistics and Agency Impact
Frequency of death by suicide in hospice settings: potential for clinicians to experience the death of a patient by suicide, with rates ranging from 25% to nearly 33% increase.
Analysis of agency data correlating closely with national data on suicide rates.
In 2019, agency data included 14 deaths by suicide, 9 being patients and 5 being family members.
Disclosure of bereavement impacts on caregivers and surviving family members when a patient dies by suicide.
Risk Factors
Common risk factors associated with higher suicide risk include:
Access to lethal means.
History of mental health issues.
Previous suicide attempts.
Social isolation and perceived burdensomeness.
Substance abuse and trauma histories.
Warning Signs
Important warning signs for suicide risk encompass behavioral changes, such as:
Mood swings and irritability.
Withdrawal from regular routines and social circles.
Expressions of hopelessness or worthlessness.
Protective Factors
Protective factors provide reasons for living, including social support, coping strategies, spiritual beliefs, and problem-solving skills.
Screening Tools and Processes
Use of the PHQ-2 and the Columbia Suicide Severity Rating Scale (CSSRS) as screening tools to gauge suicide risk.
Importance of consistent screening across all visits, ensuring accurate measurement of mood and suicidal ideation.
Embedding screening procedures into everyday practice to measure risk effectively.
Follow-up actions should be taken based on screening results to ensure patient safety.
Home Safety Assessments
Conducting assessments of home environments focused on reducing access to lethal means (particularly firearms).
Importance of questioning families about firearms and securing medications to promote safety within the home.
Interdisciplinary Approach and Roles
Emphasis on the role of the interdisciplinary group (IDG) in addressing the complex needs of patients with suicidal ideation.
Each team member plays a vital role in screening, assessment, and implementing safety plans.
Discussion about how clinicians can engage with patients and families to discuss suicide risk and prevention strategies effectively.
Response to Suicide Events
If a patient dies by suicide, conduct a root cause analysis reviewing the involvement of all clinical staff to ensure comprehensive understanding and learning from the event.
Develop a support plan for staff affected, ensuring emotional and professional support during recovery.
Conclusion
Key takeaways include the importance of consistent and systematic screening for depression and suicide risk, understanding and acknowledging the risk and protective factors, and engaging in safety planning with patients and their families.
A commitment to improving understanding, awareness, and preventive measures is vital for hospice organizations.