Mental Health

December 8, 2023

Suicide ideation response plan implemented to assist at-risk adults

Vanderbilt Health’s Adult Ambulatory clinics have a new Suicide Ideation Response Plan that will provide clinicians and staff with additional resources to provide appropriate care for patients who are identified as thinking about or planning suicide.

Vanderbilt Health’s Adult Ambulatory Clinics have a new Suicide Ideation Response Plan that will provide clinicians and staff with additional resources to provide appropriate care for patients who are identified as thinking about or planning suicide.

On Dec. 13, adult ambulatory non-psychiatric clinics will begin following a new plan, established as a standard response for screening, intervention and appropriate care for ambulatory patients ages 18 and older, who express suicidal ideation (SI) or other concerning thoughts or actions during an outpatient appointment, over the phone, via virtual messaging or during telehealth visits. A separate policy exists for patients expressing SI in inpatient settings.

“This work began with two nurses, Neuro Clinic manager Jill Shelton, RN, and care coordinator Jessica Stroh, RN, as they sought to support their teams and patients when confronted with this crisis situation,” said Vice President and Chief Nursing Officer for Adult Ambulatory Nursing Michele Hasselblad, DNP, RN, NE-BC. “We learned many other clinicians and staff were experiencing similar challenges, so we built upon the original work to develop a policy and set of tools that can be used across our clinics to provide a consistent response. This project represents superb collaboration across disciplines and entities to make a difference for our teams and our community.”

According to CDC statistics, more than half of individuals who die each year by suicide do not have a known mental health condition. Suicide remains one of the leading causes of death in the United States. In 2021, 12.3 million adults seriously thought about suicide, 3.5 million adults made a plan, and 1.7 million adults attempted suicide, according to data from the Substance Abuse and Mental Health Services Administration.

“We can do our part to save lives by screening, intervening and caring for individuals who may be thinking about or planning suicide,” said Associate Vice President of Quality, Safety and Risk Prevention Tiercy Fortenberry, MSN, RN, CPPS. “The Suicide Ideation Response Plan and related policy provide clear steps for how clinicians can intercede for those identified as being at risk.

“Suicidal ideation tools to support the completion of these steps have been added and are easily accessible in eStar, and there is role-specific SI training available in the Learning Exchange for both clinicians and staff. Training will also be provided for VUPD officers who might be asked to assist with at-risk individuals. This effort is all about saving lives,” she said.

The Columbia-Suicide Severity Rating Scale is a screening tool available in eStar. Patients are asked a series of simple, direct questions about suicidal thoughts and behaviors to help identify whether they are at risk. The tool helps determine the severity and immediacy of risk and determines the level of support the person needs.

Intervention resources added to eStar will aid staff. A key resource is the Stanley-Brown Safety Plan, an evidence-based intervention to help those experiencing self-harm and suicidal thoughts identify actions to decrease their risk of suicide and increase safety. All individuals determined to have an elevated risk will, with staff support, complete a personalized Stanley-Brown Safety Plan. The plan spells out warning signs, outlines both internal and external coping strategies and provides additional resources for support.

Storyboard notification in eStar will feature a patient’s latest Columbia Suicide Severity Rating Scale score and safety plan within the past six months.

“The incidence of depression and anxiety is increasing,” said Behavioral Health Principal Quality and Patient Safety Advisor Stacy Stark, PhD, MSN, RN. “Our staff need to be equipped to recognize and respond to patients who trust us to provide the care and resources they need, including support for their mental health, regardless of the care setting. This response policy provides staff with a standard way to address suicidal ideation using a set of evidence-based tools and resources to support our patients when they need us most and empower our staff with the confidence and the knowledge to respond safely.”

When the Suicide Ideation Response Plan is implemented a Teams line will be provided for clinical support for the first three days. Clinicians can also use the VNIS ambulatory inbox for questions:

“Our patients and families are our No. 1 priority,” said Hasselblad. “Adult ambulatory clinics are an important touchpoint for those we serve, and our new Suicide Ideation Response Plan and related policy are critical tools to guide the care of those who may be thinking about or planning a suicide. With these tools, we can better educate patients and their families, provide vital resources and intervene appropriately. Most importantly, we will save lives.”

Over the past 18 months, a small group has worked on the policy, its implementation and training. Team members and executive sponsors include: Sydney Bush-Foster, MSN, RN, Jenna Cabler, MS, Nathaniel Clark, MD, Shawn Coomer, MBA, MSN, RN, Melanie Cruz-Khalili, Suzanne Duckworth, Caroline Epps, Annette Eskew, MSN, RN, Fortenberry, Jenelle Grewell, Amy Hampton, JD, and the VUMC Office of Legal Affairs, Terri Hartman, MSN, RN, Hasselblad, Jill Jones, MD, Diane Moat, JD, RN, Julia Morris, BSM, MSN, JD, Allison Murphy, LMSW, David Posch, MS, VUPD Capt. Mike Pring, Jill Shelton, RN, Jenny Slayton, DNP, RN, Stark, Jessica Stroh, RN, Ashley Trambley, MSN, RN, Colin Walsh, MD, and Patty Wright, MD.