Zero Suicide Initiative: Can Suicide Be A Never Event? Linda - - PowerPoint PPT Presentation

Zero Suicide Initiative: Can Suicide Be A Never Event?

Linda Durst, Ellen Blair, Patricia Graham, Nancy Hubbard Zero Suicide Academy Team (ZSAT) Institute of Living, Hartford Hospital September 8th, 2016

Objectives for Today

• Describe the Zero Suicide Approach:

7 Key Components

– Present the evidence and best practices from other

• rganizations which have implemented Zero Suicide

successfully

Zero Suicide 9/8/2016 2

What is Zero Suicide?

• A methodology to eliminate suicide and a state of mind that one

suicide is too many.

• A priority of the National Action Alliance for Suicide Prevention
• A goal of the National Strategy for Suicide Prevention
• A project of the Suicide Prevention Resource Center
• A framework for systematic, clinical suicide prevention in

behavioral health and health care systems

• A focus on safety and error reduction in healthcare
• A set of best practices and tools for health systems and providers
• It is critically important to design for zero even when it may not be

theoretically possible…It’s about purposefully aiming for a higher level of performance.

Zero Suicide 3 9/8/2016

How did Zero Suicide Academy Begin?

• First ever held on June 2014 for a select group of health care
• rganizations, chosen from multiple applications both

national/international.

• Participants learned how to incorporate best and promising

practices into their organizations and processes to improve care and safety for those at risk for suicide.

• Overarching Zero Suicide Philosophy: Suicide is preventable and

health care systems need to embrace and work towards the aspirational goal of preventing ALL suicide deaths for patients in their care. If we don’t consider zero suicide a possibility we won’t work towards zero.

Zero Suicide 4 9/8/2016

Applying for Zero Suicide Academy

• Self -assessment and application process
• This presentation is not to criticize our

processes now, but to lay ground work, mind set and attitude, a different perspective.

Zero Suicide 5 9/8/2016

“Over the decades, individual (mental health) clinicians have made heroic efforts to save lives… but systems of care have done very little.”

• Dr. Richard McKeon

SAMHSA

Zero Suicide 6 9/8/2016

The Seven Essential Components of Zero Suicide

• 1. Lead
• 2. Train
• 3. Identify
• 4. Engage
• 5. Treat
• 6. Transition
• 7. Improve

Zero Suicide 7 9/8/2016

LEAD

• Create a leadership-driven, safety-oriented culture

committed to dramatically reducing suicide among people under care.

• Include survivors of suicide attempts and suicide loss in

leadership and planning roles.

• “Buy in” of leadership to support investment of staff

development, time to learn and provide resources to accomplish these initiatives.

• Formally inform organization of the plan to adopt zero

suicide philosophy.

Zero Suicide 8 9/8/2016

TRAIN

• Develop a competent, confident, and caring

workforce.

• Step 1: Assess competence of workforce in suicide

prevention.

• Tailor training to needs of workforce, i.e.

professional seminars, case conferences, training

• n established/validated tools.

Zero Suicide 9 9/8/2016

IDENTIFY

Systematically identify and assess suicide risk among people receiving care.

a) Identify high risk patients b) Screen every visit c) Contact “no-shows” reliably if they are high risk d) Alert all clinicians that touch the patient of the patient’s risk e) Potential for utilizing technology of EHR

Zero Suicide 10 9/8/2016

ENGAGE

• Ensure every individual has a pathway to

care that is both timely and adequate to meet his or her needs.

• Include collaborative safety planning and

restriction of lethal means.

Zero Suicide 11 9/8/2016

TREAT

• Use effective, evidence-based treatments

that directly target suicidal thoughts and behaviors, i.e. CAMS, DBT.

• These methods should be utilized at all

levels of care.

Zero Suicide 12 9/8/2016

TRANSITION

• The highest risk of suicide occurs during

transitions, esp. inpatient to outpatient

• Provide continuous contact and support, especially

after acute care, i.e. f/up phone calls/ letter

• Follow up closely and timely after transitions

especially after inpatient discharge.

• Ensure medications are provided until transitions

are completed.

Zero Suicide 13 9/8/2016

IMPROVE

• Apply a data-driven quality improvement

approach to inform system changes that will lead to improved patient outcomes and better care for those at risk, including metrics for current state and going forward.

• Potential for application of LEAN

Methodology to sustain improvement

Zero Suicide 14 9/8/2016

Rationale for HealthCare Systems Adopting Zero Suicide

This approach represents a commitment: – To patient safety, the most fundamental responsibility of health care – To the safety and support of clinical staff, who do the demanding work of treating and supporting suicidal patients – Suicide Care in Behavioral Health Care Settings Suicide prevention is a core responsibility for behavioral health care systems: Many licensed clinicians are not prepared, 39% report they don’t have the skills to engage and assist those at risk for suicide, 44% report they don’t have the training.

Zero Suicide 15 9/8/2016

In the month before their death by suicide:

• Half saw a general practitioner
• 30% saw a mental health professional

In the 60 days before their death by suicide:

• 10% were seen in an emergency department

Statistics

Zero Suicide 16 9/8/2016

“Suicide represents a worst case failure in mental health care. We must work to make it a ‘never event’ in our programs and systems of care.”

• Dr. Mike Hogan

National Action Alliance for Suicide Prevention

Zero Suicide 17 9/8/2016

Joint Commission Sentinel Event Alert: Recommendations

Detecting suicide ideation in non-acute or acute care settings.

• Review each patient’s personal and family medical history for suicide risk

factors

• Screen all patients for suicide ideation, using a brief, standardized,

evidence-based screening tool.

• Review screening questionnaires before the patient leaves the

appointment or is discharged.

18 Zero Suicide 9/8/2016

Immediate Action and Safety Planning

Take the following actions. using assessment results to inform the level of safety measures needed.

• Keep patients in acute suicidal crisis in a safe health care environment under one-

to-one observation.

• For patients at lower risk of suicide, make personal and direct referrals and

linkages to outpatient behavioral health and other providers for follow-up care within one week of initial assessment, rather than leaving it up to the patient to make the appointment.

• Conduct safety planning by collaboratively identifying possible coping strategies

with the patient and by providing resources for reducing risks

• Restrict access to lethal means

9/8/2016 19 Zero Suicide

Discharge Planning, Patient Education &Documentation Recommendations

• Establish a collaborative, ongoing, and systematic assessment and

treatment process with the patient involving the patient’s other providers, family and friends as appropriate.

• To improve outcomes for at-risk patients, develop treatment and

discharge plans that directly target suicidal ideation.

• Educate all staff in patient care settings about how to identify and

respond to patients with suicide ideation.

• Document decisions regarding the care and referral of patients with

suicide risk

9/8/2016 20 Zero Suicide

Model Performance Improvement Plan

• Identify leadership in your institution to implement recommendations.
• Survey competence/confidence of your staff about suicide care and

assessment

• Screening using PHQ-2 and 9 should be implemented in all settings.
• Implement Follow Up Phone Calls.
• Increase education to all health care disciplines and in all settings, not only

psychiatric, re: suicide care and prevention, i.e. VA treatment plan, nice plan for individual with suicidal ideation.

• Increase collaboration between psychiatry and non-psychiatric settings; Plan

grand rounds/ case conferences/Suicide Prevention Rounds.

• Utilize Grants that are available to support organization’s efforts in suicide

prevention and care.

• Lethal Means restriction- address in all areas
• Utilize electronic health record to track suicide ideation as primary symptom to

guide us in suicide care planning and follow-up.

9/8/2016 21 Zero Suicide

High Reliability Organization (HRO)

• The Zero Suicide approach lends itself nicely to

the high reliability culture of HHC

• Make the commitment to become an HRO and

reaching zero on several very important

• utcomes, such as hand washing, bloodstream

infections, falls and ventilator-associated pneumonia- so why not suicide?

• This is a Joint Commission goal for transforming

healthcare.

Zero Suicide 22 9/8/2016

Zero Suicide Culture Saves Lives

Health and behavioral health care organizations have found:

• Elements of this culture can be implemented without additional

funding.

• This culture reduces death by suicide.
• Healthcare Systems Using The Zero Suicide Approach:

– Henry Ford Health System, Detroit, MI – Centerstone, Tennessee – Catholic University of America, Washington, D.C., David Jobes: Showing early evidence of success with CAMS tool, with progression towards validation of this tool

Zero Suicide 23 9/8/2016

Zero Suicide at the IOL: 1 Year Later

• Grand Rounds Presentation 10/1/2015
• Letter to organization introducing ZS from Dr. Schwartz November 2015
• Leadership ZS Academy Team, Meets Monthly
• Zero Suicide Champions Group, Meets Monthly
• Monthly State Learning Community
• Monthly Clinician Seminars
• Workforce Survey-Spring of 2016
• Training: C.A.S.E., QPR, ASIST, C-SSRS
• Incorporating ZS into EPIC
• Piloting Follow Up Calls starting first quarter FY 2017
• Plan for FY17-Year 2 Plan
• Incorporating Update into Employee Monthly Message

Zero Suicide 24 9/8/2016

9/8/2016 25

Thank You! Questions?

Zero Suicide