Title: Promoting the use of “ask suicide screening questions” in a pediatric neurobehavioral unit
Abstract:
Background: Suicide is the second leading cause of death in children and adolescents with increasing rates over the past decade. Individuals living with autism spectrum disorder (ASD), as well as other neurological or developmental conditions such as ADHD or learning disabilities, are nine times more likely to experience suicidal ideation and six times more likely to attempt suicide than their peers. S Suicide risk is often under-recognized in this population. The "Ask Suicide Questions" (ASQ) tool is a valid and reliable tool used in suicide screening in this population, aged eight years and older to detect risks better and prevent suicidal behavior. Previously, the pediatric Neurobehavioral Unit only administered suicide screening during the admission process with the parents.
Objectives: The aim of this quality improvement project is to integrate biweekly screenings using the validated "Ask Suicide Questions" (ASQ) tool with patients who have autism and other developmental disabilities within a pediatric inpatient Neurobehavioral Unit.
Method: Over a 15-week period. Registered Nurses (RNs) are screening all verbal patients who are 8 years and above, at the time of the admission process and, subsequently, on the second and fourth Tuesdays of each month. A referral is created within 30 minutes of screening to the psychiatrist for any positive response to any of the questions. The data is collected with weekly chart audits. and entered in a HIPPA protected database.
Results: Preliminary results show 100% (n=4) screenings since the commencement of implementation in patients who were able to answer the questions. There was one positive screen in which the patient stated “yes” to the question “in the past week have you wished you were dead?” The patient smiled widely and put both of her thumbs up to indicate “yes” when she answered. Upon additional questioning, she denied having thoughts of wanting to be dead or causing self-harm. Due to this patient having a high degree of attention-seeking behavior it was decided that she would not undergo further suicide screening. Feedback on improvement of documentation was provided to the RN and psychiatrist.
Conclusions: Preliminary findings suggest that biweekly screenings using the ASQ tool can be performed in the patient population of individuals with autism or other neurologic disabilities who have severe behavioral disturbances and are hospitalized on an inpatient unit. However, difficulty with understanding the language and the need to determine if an individual will make quasi-suicidal statements for attention needs to be considered clinically for each individual undergoing suicide screening. Continued adherence to this screening protocol is expected to improve early intervention with the potential to reduce suicidal behavior within this vulnerable population. Feedback on documentation of the screening procedure and documentation by the RNs and psychiatrists should improve the use of the screening procedure.
