Reducing Inpatient Suicide Hazards at Veterans Administration Hospitals

• 2/12/2010
• Author: Steven Berman
• Category: The Journal Blog
• 14677 Views
• 0 Comments
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This week, Peter Mills, the senior author of " A Checklist to Identify Inpatient Suicide Hazards in Veterans Affairs Hospitals,” which appears in the February 2010 issue, guests on the Journal blog. In the article, Dr Mills and his colleagues report on the first study to examine the implementation and effectiveness of a standardized checklist for mental health units. Dr. Mills, a member of the Journal’s Editorial Advisory Board,  provides an update on recent data concerning the findings across the 113 VA facilities that have been using the checklist. The Journal welcomes your comments.

As we reported in the article on the first year’s experience, 113 VA facilities used the Mental Health Environment of Care Checklist (http://www.patientsafety.gov/SafetyTopics.html#mheocc), which was designed to review the environment of care in mental health units in VA hospitals and identify environmental hazards for suicidal patients. As of the end of fiscal year 2008 (October 31, 2008), 7,642 hazards had been identified, of which 5,834 (76.3%) had been abated. Throughout 2009 and into 2010, VA facilities have continued to use the checklist to evaluate their mental health units on a quarterly basis. As this process has unfolded, we have worked with manufacturers to develop specialized products for use in mental health facilities and have made recommendations to the field.  At the same time, new hazards have been identified and communicated to the field, and the checklist has been updated accordingly. By the end of fiscal year 2009 (October 31, 2009), the facilities had identified 9,786 hazards—reflecting 2,144 new hazards, of which 8,298 (84.8%) have been abated (see table). I would like to emphasize that while there are still 13 level-5 (“critical”) and 380 level-4 (“serious”) hazards that have not been abated, all these hazards have a specific mitigation plan to reduce the risk of the hazard to patients on the unit. For example, areas with the identified hazards are locked or continuously observed while patients are present. All facilities with level-4 hazards are required to submit a plan to mitigate any hazards that will not be abated in a timely manner, and all level-5 hazards are to be abated or mitigated within 24 hours. In this way, the hazard is reduced immediately even for hazards that may require new construction or significant environmental changes to resolve.

The fact that more than 2000 new hazards were identified in our mental health units in the second years of the checklist’s use suggests that as the more obvious hazards such as anchor points and security issues are identified and abated, the staff begins to recognize more subtle hazards, such as suffocation using plastic material from shower curtains and the potential to shut lanyards in the sides of doors to hang. Also, as incidents happen in our facilities we are able to alert all facilities in our system to the causes and potential hazards to look for.    


Table. Status of Hazards by Risk Level