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OtherSPECIAL ARTICLE

Reducing Inpatient Suicide Risk: Using Human Factors Analysis to Improve Observation Practices

Jeffrey S. Janofsky
Journal of the American Academy of Psychiatry and the Law Online March 2009, 37 (1) 15-24;
Jeffrey S. Janofsky
MD
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    Figure 1.

    Ideal observation workflow.

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    Table 1

    Terminology Used for Inpatient Observation Levels Across Health Care Systems

    TerminologySourceReference
    Continuous, periodic checks, constant arm's-length, 1:1American33
    1:1 (constant), Q 15-minute checks, Q 30-minute checks, general suicide observationAmerican34
    Close observation, one-on-one observationAmerican26
    Levels 1, 2, 3, 4American35
    Special observation, constant observationAustralian36
    Close observation, special observationAustralian37
    Continuous observationCanadian38
    Special supervisionEnglish39
    Special observation (red, amber, blue, green)English40
    General, close (intermediate), specialEnglish41
    ConstantEnglish3
    Special observation, maximum observation, constant observation, constant supervisionEnglish42
    Non-routine, medium-level, high-levelEnglish and Welsh32
    Intermittent observation, within eyesight observation, special observationEnglish NSH Trusts29
    Close, special, constant (CO)English NSH Trusts43
    Close observation, special observationIrish5
    General observation, constant observation, special observationScottish4
    General observation, 15-minute observation, close observation, special nursingScottish44
    Formal observation, continuous observationUnited Kingdom45
    Specialing, one-to-oneWelsh46
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    Table 2

    Typical Patient Support List Entries

    Symptoms/behaviors
        Hears voices.
        Does not eat, sleep, or bathe when at home.
        Fights with neighbors and talks to herself and to her deceased mother.
        Has paranoid feelings about her neighbors; feels threatened by them.
        Feels depressed.
        Was violent in the emergency room; threw a phone at staff; required injected medications to calm down.
        Elopement risk; trying doors and eloped to the elevator vestibule five days ago.
        Became agitated, assaulted security officer, and required seclusion yesterday.
        Is 18 weeks pregnant.
    What you should do to help the patient
        Encourage patient to eat and attend to activities of daily living.
        Reassure patient of her safety on the unit.
        Monitor in the bathroom; patient vomited two nights ago.
    When you should contact patient's nurse
        Patient is not following redirection.
        Patient states that she wants to hurt herself or someone else.
        Patient complains of pain.
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Journal of the American Academy of Psychiatry and the Law Online: 37 (1)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 37, Issue 1
March 2009
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Reducing Inpatient Suicide Risk: Using Human Factors Analysis to Improve Observation Practices
Jeffrey S. Janofsky
Journal of the American Academy of Psychiatry and the Law Online Mar 2009, 37 (1) 15-24;

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Reducing Inpatient Suicide Risk: Using Human Factors Analysis to Improve Observation Practices
Jeffrey S. Janofsky
Journal of the American Academy of Psychiatry and the Law Online Mar 2009, 37 (1) 15-24;
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    • Abstract
    • Errors in Medical Practice
    • Inpatient Suicide
    • Epidemiology: Inpatient Suicide and Observation
    • Standardizing and Improving Psychiatric Observation Practices
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