Columbia Suicide Severity Rating Scale

What is it? The Columbia Suicide Severity Rating Scale (C-SSRS) is an evidence-based suicide risk screening assessment tool recommended in the Joint Commission Best Practice Library. Mental health training is not required to administer the screening Successfully used for screening by hospitals, outpatient areas, first responders, military Built into Epic exactly as it is designed

Why do it? Identifying patients at risk for suicide is one of the 2017 Joint Commission National Patient Safety Goals (NPSG.15.01.01) Highest suicide rates in the nation in 30 years 10th leading cause of death in the U.S. 2nd leading cause of death among those aged 10 – 24

How do I do it? The scale is completed upon entry to the hospital Ask the questions exactly as they are written Some questions (2 and 6) only cascade open if a patient answers “yes” to a previous question. Screen shots to be updated Specific location in Epic to be noted

Action for “Yes” Response How do I do it? Actions are required of you if the patient answers “yes” to a question. The Chart below describes your responsibility Use largest number question with a “yes” answer to drive action of care Question # Action for “Yes” Response #1 Notify Case Manager/Social Worker to provide outpatient behavioral health information at discharge #2 #3 Contact Psychiatric RN Liaison #4 Ask admitting service to assess patient safety; suggest psychiatric consult #5 Initiate 1:1, ask admitting service to order psych consult (required) DETAILED ON THE NEXT SLIDE #6 < 1 week: initiate 1:1, ask admitting service to order psychiatric consult 1 week – 3 months: Contact Psychiatric RN Liaison > 3 months, notify Case Manager/Social Worker to provide outpatient behavioral health information at discharge This slide needs to be updated with a current grid that we would link in EPIC

How do I do it? Question #5 addresses active suicidal ideation with a plan and intent to act. “Have you started to work out or worked out the details of how to kill yourself? Do you intend to carry out this plan” If a patient answers “yes” to question 5: Initiate a safety assistant Alert the physician Ask him or her to enter an order for: Suicide risk 1:1 monitoring A psychiatric consult.

Action for “Yes” Response Question Your patient answers “yes” to questions 1, 2, and 3 on screening, but “no” to 4, 5, and 6. What do you do? Put the patient with a 1:1 safety assistant Call/page the psych nurse liaison Notify Case Management A and C Question # Action for “Yes” Response #1 Notify Case Manager/Social Worker to provide outpatient behavioral health information at discharge #2 #3 Contact Psychiatric RN Liaison #4 Ask admitting service to assess patient safety; suggest psychiatric consult #5 Initiate 1:1, ask admitting service to order psych consult (required) #6 < 1 week: initiate 1:1, ask admitting service to order psychiatric consult 1 week – 3 months: Contact Psychiatric RN Liaison > 3 months, notify Case Manager/Social Worker to provide outpatient behavioral health information at discharge

References Centers for Disease Control and Prevention. (2016). Leading Causes of Death. Retrieved from https://www.cdc.gov/nchs/fastats/leading-causes- of-death.htm National Alliance on Mental Illness. (2017). Risk of Suicide. Retrieved from http://www.nami.org/Learn-More/Mental-Health-Conditions/Related- Conditions/Suicide National Alliance on Mental Illness. (2017). Mental Health by the Numbers. Retrieved from http://www.nami.org/Learn-More/Mental-Health- By-the-Numbers The Columbia Lighthouse Project. (2016). About the Scale. Retrieved from http://cssrs.columbia.edu/the-columbia-scale-c-ssrs/about-the-scale/ The Joint Commission. (2017). Hospital National Patient Safety Goals. Retrieved from https://www.jointcommission.org/assets/1/6/2017_NPSG_HAP_ER.pdf