A checklist to identify inpatient suicide hazards in veterans affairs hospitals

Approximately 1,500 suicides take place in inpatient hospital units in the United States each year. This study, the first of its kind, examines the implementation and effectiveness of using a standardized checklist for mental health units to improve patient safety in a large health care system.

In 2006 a Department of Veterans Affairs (VA) committee was charged with developing a checklist to explicitly identify environmental hazards on acute mental health units treating suicidal patients. The committee developed both general guidelines to be applied to all areas of the psychiatric unit and detailed guidelines for specific rooms, such as bathrooms, bedrooms, and seclusion rooms.

Some 113 VA facilities used the Mental Health Environment of Care Checklist to evaluate their mental health units, identifying and rating 7,642 hazards. At the end of the first year of the project, because of the checklist, 5,834 (76.3%) of these hazards had been abated by facilities; approximately 2% were identified as critical hazards, and another 27% were rated as serious. The most common hazard was anchor points for hanging, followed by material that could be used as a weapon against staff or other patients and problems keeping patients in the secured unit environment. Anchor points had the greatest risk-level classification, followed by suffocation risk and poison risk. High-risk locations included bedrooms and bathrooms.

Anchor points represented almost 44% of the total number of identified hazards, and materials that could be used as weapons comprised nearly 14% of the total. It is critical to review the mental health environment of care with an eye for these potential weapons. The checklist and resulting mitigations of hazards represent steps toward the overall goal of preventing inpatient suicides.