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Professional News
Meeting JCAHO Requirement Made Easier by APA
Psychiatric News
Volume 41 Number 24 page 5-27

APA has made a new tool available to hospitals and behavioral health care facilities that can help them meet new suicide-prevention requirements from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

APA and the National Association of Psychiatric Health Systems have issued a CD recording of a November telephone conference call with experts in suicide-risk assessment and JCAHO officials that outlines steps health care organizations can take to comply with the JCAHO mandate that they identify patients at risk for suicide.

The JCAHO mandate, effective January 1, 2007, will require those facilities to use established tools to assess patients' risk of suicide and identify those in danger of attempting suicide

To help facilities meet JCAHO's requirements, APA provided an expert involved in the development of its Practice Guideline for the Assessment and Treatment of Patients With Suicidal Behaviors to discuss approaches with JCAHO officials on the conference call. Douglas Jacobs, M.D., president and CEO of Screening for Mental Health Inc. and chair of the APA work group that developed the practice guideline, discussed the implementation issues with Robert Wise, M.D., vice president for standards in JCAHO's Division of Standards and Survey Methods.

The commission mandate requires several steps from the affected facilities:

The new requirement stems in part from suicide's rank as the most frequently reported sentinel event, or adverse patient condition, for which the JCAHO requires facilities to conduct a retrospective error analysis. The JCAHO defines a sentinel event as "an unexpected occurrence involving death or serious physical or psychological injury, or risk thereof. . . .Such events are called `sentinel' because they signal the need for immediate investigation and response." These events do not arise directly from a patient's condition.

Since 1995, there have been 3,811 sentinel events reported to JCAHO. Patient suicide was reported 501 times, or 13.1 percent of all sentinel events, which made it the leading type of sentinel event reported. The total number of sentinel events reported to JCAHO increased from 23 in 1995 to 582 in 2005, including 56 suicides last year. JCAHO officials acknowledged that the high-profile nature of suicide also may contribute to its being among the most-reported sentinel events.

"These data also support the importance of establishing National Patient Safety Goals and focusing our energies on addressing serious errors within health care organizations," said JCAHO in a written statement.

The commission first issued a special alert on suicide incidents in hospitals and specialized psychiatric care settings in 1998, which included a breakdown of root causes of inpatient suicide and recommendations for its prevention.

Suicide rates among current and former psychiatric patients are about five times higher than the rate among the general population. An estimated 10 percent to 13 percent of people with schizophrenia kill themselves, as do between 15 percent and 17 percent of people with bipolar disorder. These statistics compare with a suicide rate of less than 1 percent in the general population, according to the Treatment Advocacy Center.

Information on ordering the CD is posted at<www.naphs.org/Teleconference/suicide.html>. Information on the JCAHO requirements is posted at<www.jointcommission.org/NR/rdonlyres/98572685-815E-4AF3-B1C4-C31B6ED22E8E/0/07_HAP_NPSGs.pdf>. APA's practice guideline on suicide is posted at<www.psych.org/psych_pract/treatg/pg/pg_suicidalbehaviors.pdf>.

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