Suicide Awareness

Charting Examples

Patient who is an Active Immediate Risk for Suicide

Key Factors to Cover:

Fictional Example:

Met with patient after report patient told RN during medication review “I need to admit that I just bought a bunch of Tylenol and I think I am going to kill himself later today”.

While speaking to author patient reported before coming to his appointment today he had purchased a large container of Tylenol at the grocery store. He feels he is at risk of taking them when he returns home. Stating he has been experiencing suicidal ideations for the past month and made his first and only history of attempting to kill himself three months ago, stating “I took 5 Ambien [sleeping pill prescribed] three months ago because I couldn’t handle it anymore and wanted to die, but then woke up the next morning, so I guess it wasn’t my time”. When asked if patient was actively thinking about suicide stated “Yes I am, I bought the Tylenol hoping it will be stronger I read an article about how dangerous it can be”.

Patient was asked if he would like to go to an emergency room voluntarily today for further evaluation, patient refused stating “no, I think just talking to you will hold me off for the day”.

Author completed a Columbia-Suicide Severity Rating Scale Screen Version, patient answered yes to all 6 questions indicating a high risk for suicide risk. See scanned Columbia.

Patient does meet the criteria for an M1 Hold at this time as he reported suicidal ideations to author stating “Yes, I am having thoughts of killing myself, I have a plan to overdose on my medications” and bought a large bottle of Tylenol indicating an immediate high risk.  

Patient was transferred via ambulance on an M1 Hold to St Joseph’s hospital. Patient was read his rights by author and stated “I understand” after signing them.

Patient provided a copy of his M1 Hold and Rights section, original provided to Paramedics for hospital, and copy provided to medical records.

Patient was never left alone during evaluation and transferred to St Josephs via ambulance, author gave report to Dr Jones at St Joseph’s Emergency Department.

 

Patient who is not an Active Risk for Suicide

Key Factors to Cover:

  • Reason for Evaluation (comments made in quotations)

  • Length of time

  • Active Thoughts

  • Past History of Attempts

  • Current/History of seeing Mental Health providers

  • Offered a List of mental health providers, provided or reason not

  • Offered to be seen today by a mental health provider

  • Completed Safety Plan (if applicable)

  • Protective Factors covered

  • Weapons in the home or not.

  • Provided national helpline numbers

  • Encouraging to go to an ER or call 911

Fictional Example:

During conversation with occupational therapist patient stated “It would be easier if I just could go to sleep and never wake up again”. Patient further stated to occupational therapist “About two months ago I thought about taking all of my medications but I didn’t”.

Patient completed Columbia-Suicide Severity Rating Scale Screen Version with author. Patient stated he has for the last four months been having thoughts before he goes to sleep of “I am ok, if I don’t wake up tomorrow”. He reported two months ago after a fight with his wife about his medical bills he had a “fleeting thought about taking all of my medications that night”. Patient states he did not take them because his wife was with him and he did not “really want to die at that time I just feel guilty that I am the reason we are straining our bank account, it would just be easier if she didn’t have my issues to deal with, but I know if I die that would be worse for her”. Patient denied active thoughts of suicide at this time, stating “no, I don’t want to die but I am over being sick all the time” Patient denied any past history of attempts, stating “I am not brave enough to actually try”.

Patient states he is not currently seeing a mental health provider, stating he saw a provider when he was a teenager for “family issues”. He states he would be interested in seeing a new mental health provider again, patient was provided a list of providers from his insurance. He was offered the option for patient to be seen at an inpatient facility today, patient refused. Stating “I don’t want to kill myself or die, I am not thinking about that, I just am over being sick and think I could wait to see someone in the office”. Patient and author completed a safety plan, see scanned plan in EMR. He recognizes his warning signs of crisis developing when he becomes worried about bills and starts to think more plans then wishes to not wake up. His internal coping strategies include talking with his pastor, going for a walk, and watching a funny TV show. He reported he has support systems including his wife, pastor, and his best friend whom he calls on a regular basis.

Patient provided contact information for the National Suicide Prevention Lifeline and Colorado Crisis Centers, in addition to a current list from patient’s insurances website for a mental health provider. He stated he would call them. Author and patient also reviewed calling 911 or going to the nearest emergency room if he is in a crisis. Patient does not have any weapons in the home and agreed to staying out of the bathroom where his medications are kept without his wife present. Protective factors covered with patient include; identifying reasons to live, responsibility to family, supportive social network, a fear of dying, and willingness to discuss his feelings with author and others.

Patient does not meet the criteria for an M1 Hold at this time as he denied active suicidal or homicidal ideations to author and does not fit the definition of "gravely disabled" Colorado Statute 27-10-102. As patient shows sign of cognition recognizing staff and requesting staff at NJH. He shows no indications of being in danger of serious physical harm due to the inability or failure to provide the essential human needs of food, clothing, shelter, and medical care. He does not demonstrate a significant lack of judgment in managing resources and interacting with others that his health and safety are significantly endangered and he lacks the capacity to understand that this is the case.