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Tip of the week: Proper care planning can prevent resident suicide, deter depression

Contemporary Long-Term Care Weekly, August 14, 2008

Just last week, Renee Jones was an active, social, working woman. At 76 years old, she got up every morning and walked two miles before driving to her job as a secretary for an oil company.

Then she had a debilitating stroke. Now she must rely on another person to bathe, feed, and toilet her. She has lost her dignity and has spiraled into a deep depression. The joyous life that she once knew no longer exists.

Resident depression is a serious matter. In many instances, severe depression leads to thoughts of dying and attempts to kill oneself. In some unfortunate cases, the depressed person is successful.

It is important to spot signs of depression, which might lead a resident to attempt suicide. It then becomes your job to create a care plan to prevent suicide accordingly, says Holly Sox, RN, RAC-C, MDS coordinator at NHC Lexington in West Columbia, SC, and clinical services manager at Robintek in Worthington, OH.

Being a good detective

How many times have you seen a resident’s emotional well-being decline? How often have you wondered whether this resident will harm him- or herself? Is this resident capable of suicide?

For example, there are residents who talk about dying and killing themselves and who have a plan to commit suicide. And there are residents who are depressed, but don’t have the ability to be suicidal, explains Carol Maher, RNC, RAC-C, director of clinical reimbursement for Ensign Facilities, Inc., an extension of the Ensign Group in Mission Viejo, CA.

It takes good assessment skills to determine whether a resident is suicidal. Make note that many elderly people don’t like to complain about their situation or health problems. Maher recommends watching for certain warning signs, including

·  sitting in a dark room

·  talking to anyone about suicide

·  collecting items that could be used to commit suicide (e.g., cutlery, glassware, medication)

·  asking visitors to bring in weapons or items that could be used as weapons (e.g., asking for family to bring a cake and a knife to cut it)

·  no longer eating or taking medication

“It’s always important to keep in contact with families of residents,” Maher says. Families notice when their relatives’ eating habits, moods, or sleeping patterns are different.

Prevention is key

Providing the safest environment possible is the first step to suicide prevention, says Sox.

Once a resident expresses the desire to commit suicide, possible approaches to ensuring his or her safety are

·  providing a closely supervised atmosphere along with one-on-one care

·  removing harmful objects (e.g., cutlery, glassware, ballpoint pens, plastic bags, items with cords, shoelaces, etc.)

·  ensuring that the resident has swallowed all administered medication, so he or she can’t use it to overdose

Care plan particulars

Both Maher and Sox agree that the goal of a suicide care plan is to minimize the risk for residents of hurting themselves.

Be aware that there are different guidelines available when developing a care plan. If your facility has an accepted clinical practice policy or a plan in the policy and procedure manual, always turn to those first to develop your formal plan, recommends Sox.

When documenting the problem in the care plan, Sox suggests stating that the resident has “the potential for harm to self related to depression, bipolar disorder, etc., and evidenced by a suicidal statement, repetitive suicide attempts, or a history of suicide attempts.” (For a sample suicide prevention care plan, turn to p. 9 of the PDF of this issue.)

Once a resident exhibits suicidal tendencies, you need to provide immediate and frequent evaluations. If the resident is actively suicidal, he or she must be evaluated daily. Once the resident is out of immediate danger, you can spread out the time between evaluations to see how the resident improves, Sox says.

When one-on-one care with a potentially suicidal resident lasts for more than 24 hours, the resident should be admitted to an inpatient psychiatric unit.

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