Psychiatr News December 15, 2006
Volume 41, Number 24, page 5
© 2006 American Psychiatric Association
Meeting JCAHO Requirement Made Easier by APA
Rich Daly
Suicide is the most-reported sentinel event in JCAHO reports, and
intensified efforts are now under way to reduce its incidence.
APA has made a new tool available to hospitals and behavioral health care
facilities that can help them meet new suicide-prevention requirements from
the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
APA and the National Association of Psychiatric Health Systems have issued
a CD recording of a November telephone conference call with experts in
suicide-risk assessment and JCAHO officials that outlines steps health care
organizations can take to comply with the JCAHO mandate that they identify
patients at risk for suicide.
The JCAHO mandate, effective January 1, 2007, will require those facilities
to use established tools to assess patients' risk of suicide and identify
those in danger of attempting suicide
To help facilities meet JCAHO's requirements, APA provided an expert
involved in the development of its Practice Guideline for the Assessment and
Treatment of Patients With Suicidal Behaviors to discuss approaches with JCAHO
officials on the conference call. Douglas Jacobs, M.D., president and CEO of
Screening for Mental Health Inc. and chair of the APA work group that
developed the practice guideline, discussed the implementation issues with
Robert Wise, M.D., vice president for standards in JCAHO's Division of
Standards and Survey Methods.
The commission mandate requires several steps from the affected
facilities:
- Identifying specific factors and features that may increase or decrease
risk for suicide during and after hospitalization.
- Addressing patients' immediate safety needs and the most appropriate
setting for treatment.
- Providing information to patients and family members about
suicide-prevention resources, such as hotlines, to which they can turn in
crisis situations.
The new requirement stems in part from suicide's rank as the most
frequently reported sentinel event, or adverse patient condition, for which
the JCAHO requires facilities to conduct a retrospective error analysis. The
JCAHO defines a sentinel event as "an unexpected occurrence involving
death or serious physical or psychological injury, or risk thereof. . . .Such
events are called `sentinel' because they signal the need for immediate
investigation and response." These events do not arise directly from a
patient's condition.
Since 1995, there have been 3,811 sentinel events reported to JCAHO.
Patient suicide was reported 501 times, or 13.1 percent of all sentinel
events, which made it the leading type of sentinel event reported. The total
number of sentinel events reported to JCAHO increased from 23 in 1995 to 582
in 2005, including 56 suicides last year. JCAHO officials acknowledged that
the high-profile nature of suicide also may contribute to its being among the
most-reported sentinel events.
"These data also support the importance of establishing National
Patient Safety Goals and focusing our energies on addressing serious errors
within health care organizations," said JCAHO in a written
statement.
The commission first issued a special alert on suicide incidents in
hospitals and specialized psychiatric care settings in 1998, which included a
breakdown of root causes of inpatient suicide and recommendations for its
prevention.
Suicide rates among current and former psychiatric patients are about five
times higher than the rate among the general population. An estimated 10
percent to 13 percent of people with schizophrenia kill themselves, as do
between 15 percent and 17 percent of people with bipolar disorder. These
statistics compare with a suicide rate of less than 1 percent in the general
population, according to the Treatment Advocacy Center.
Information on ordering the CD is posted at
<www.naphs.org/Teleconference/suicide.html>.
Information on the JCAHO requirements is posted at
<www.jointcommission.org/NR/rdonlyres/98572685-815E-4AF3-B1C4-C31B6ED22E8E/0/07_HAP_NPSGs.pdf>.
APA's practice guideline on suicide is posted at
<www.psych.org/psych_pract/treatg/pg/pg_suicidalbehaviors.pdf>.
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