Suicidal Protocol in Blood and Marrow Outpatient Transplant Setting

This information is intended to give background and intervention options for healthcare professionals in the transplant outpatient setting dealing with patients that are at risk for suicide.

In 2007, there were 34,598 deaths by suicide in the United States.  Suicide is the fourth leading cause of death in adults, ages 18 to 65 years.  According to the Annals of Oncology persons diagnosed with cancer have double the risk of committing suicide compared to the general population.

It is important to identify those patients who are at greatest risk of suicide.   Symptoms of suicidal ideation include feelings of hopelessness, anhedonia, insomnia, depression, severe anxiety, impaired concentration, psychomotor agitation, panic attack, and severe remorse.  The Health Care Provider needs to establish an atmosphere of trust to encourage the patient to express their current symptoms.  There are tools available for health care providers in outpatient clinics that can provide the ability to calculate the patient’s risk.  Some of those tools include but are not limited to the Beck Scale, BSI 18, and SAFE T.

This program has experienced loss due to suicide in the past several years.  The program subsequently developed a suicide protocol to help identify those patients at greatest risk for suicide.  The entire staff was trained on suicidal ideations and at risk behaviors.  When the staff identifies a potential suicide risk the team is called and further evaluation is completed.  The suicide protocol team consists of a nurse and social worker. The process is explained to the patient and caregiver.  The nurse manager and the patient’s physician are notified of the situation.   A family member or another staff member stay with the patient at all times to maintain a safe environment.  We have identified a crisis team with a nearby psychiatric facility that will provide further evaluation and recommend a plan, if the patient is determined to be at risk for suicide.  If the patient appears safe to return home the patient and family are instructed how to make the home safe.  The patient will receive a follow up phone call and continued monitoring.

Since the initiation of this protocol the facility has not had a suicide attempt or completion.