The document outlines suicide precaution protocols, including two levels of precautions - Level I and Level II. Level II precautions involve one-to-one observation and restrictions of potentially dangerous items. Level I allows for some independence but requires close staff monitoring. Nursing responsibilities are described for assessing and caring for suicidal patients, with the goal of ensuring safety and identifying support systems. Additional protocols are specified for involuntary 72-hour holds.

1. Suicide Precautions
Crisis Intervention:
The goal of crisis intervention is prompt recognition of
escalating behavior and early intervention to assist the patient
in regaining behavioral control
To ensure the protection of all patient rights while maintaining
an acceptable level of patient/staff safety, all procedures
limiting a patient’s activities are implemented according to
rules and regulations of the Arkansas Department of Health
and other applicable standards

2. Suicide Precautions (continued)
Level II Precautions:
 When “suicide precautions” without a specific level are ordered by
the physician, Level II interventions are implemented
 Level II precautions means the patient is at moderate-high risk of
self-injurious behavior
 Responsibility of staff members caring for Level II suicidal patients
are:
• Nursing (licensed or unlicensed) is assigned to one-to-
one observation
• This includes while toileting, sleeping, during visitation
times and even during diagnostic procedures
• The patient is restricted to the nursing unit unless
accompanied by a member of the nursing staff

3. Suicide Precautions (continued)
• Medications are given in oral liquid form to prevent hoarding
of medication at the MD’s discretion
• The patient is not allowed access to potentially harmful
objects (belt, sharp objects, matches, cigarette lighters, glass
containers, plastic bags, cleaning solutions, etc)
• Patient is allowed to have visitors but staff observation is
maintained throughout the visit
• If at anytime nursing staff observes escalation of the patient’s
suicide risk/behavior, the physician is notified immediately
• Suicide precautions are explained to the patient and to all
visitors entering the room
*All patients admitted on a 72 hour hold are monitored in
Level II Precautions*

4. Suicide Precautions (continued)
Level I Precautions:
A patient judged by the physician to be at somewhat lower
risk of suicide is ordered Level I precautions.
Nursing responsibilities for a level I patient include:
• The staff is aware of the patient’s whereabouts and activities
at all times
• If leaving the unit, the patient is attended by a staff member
(may be any hospital associate)
• The patient is admitted or moved to a room centrally located
and within view of the nursing station
• The door remains open unless another person is with the
patient

5. Suicide Precautions (continued)
• Sharp objects may be used while the patient is observed by a
staff member, but hazardous materials are not left in the
patient’s possession when a staff associate is not physically
present
• These interventions are explained to the patient and all visitors
• A specific staff person is designated to be responsible for the
patient at all times during each shift
• If the designated staff associate must leave the unit,
information & responsibility for supervision of the patient is
transferred to another staff associate

6. Suicide Precautions (continued)
• The patient is checked at frequent but irregular intervals to
ascertain safety and whereabouts
• Closer observation of the patient is maintained at times when
decreased numbers of staff are present or increased level of
activity is present on the unit
• To prevent hoarding of lethal quantities of meds, swallowing of
meds is observed carefully
• The patient may have visits with family/significant others
without staff members present - instructions are given to visitors
regarding restricted articles that are not to be given to the
patient

7. Suicide Precautions (continued)
Nursing Care for the Suicidal Patient:
 Assessment Parameters: Document information regarding
past attempts, ideation, and family history upon admission
 Note behavior throughout the day, structured vs. unstructured
unit activities, patient interaction with other people, task
performance, activities, and attention span
 Observe, record, and report any mood changes
 Watch for behaviors such as decreased
communication, conversations about
death, disorientation, disinterest in surroundings, and
concealing harmful objects

8. Suicide Precautions (continued)
 Nurse-Patient Interactions: Do not promise confidentiality
regarding information received about suicide plans
 Discourage excessive discussion of previous attempts
 Convey an accepting, nonjudgmental attitude
 Encourage patient to ventilate feelings
 Do not belittle previous attempts as “gestures” or manipulative
efforts
 Help the patient identify positive aspects of himself or his life
situation
 Involve the patient in planning care and understanding
interventions and assist the patient with identification of
support systems for use at discharge

9. Suicide Precautions - 72 Hour Hold
A patient is subject to involuntary detention or a 72 hour hold when
determined to be a danger to themselves or others
When patients are placed in a 72 hour hold;
• The physician must write or give the order
• The 72 hours does not include weekends or holidays
• The patient must receive a written copy of their rights AND have their
rights READ ALOUD within 60 minutes of the hold order
• Rights presentation occurs with a witness and the patient is asked to
sign a statement whether they agree or disagree
• The patient can disagree but not provoke the “hold”
• Supervisor is notified when a patient is placed in a 72 hour hold
• 72 hour hold patients are on Level II suicide precautions, which includes
one-to-one observation