Systematic Screening for Suicidal Ideation in an Ambulatory Oncology Harm Reduction Clinic
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Date
2024-05
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The Ohio State University
Abstract
The risk of suicide among patients with cancer is up to four times greater than the general population and up to seven times greater within the first 6 months after cancer diagnosis. National clinical practice guidelines (CPGs) and a National Patient Safety Goal (NPSG) from the Joint Commission provided rationale for selecting patients who should be screened for suicidal ideation (SI). However, routine SI screening at the Ohio State University Wexner Medical Center James Comprehensive Cancer Center (OSUWMC James) was only required in the emergency department (ED) and inpatient units. Patients in the ambulatory setting received depression screening informed by an internal practice guideline. The purpose of this initiative was to systematically implement routine suicide screening in an outpatient cancer supportive care clinic for patients with an increased risk for SI. A sub-objective within the project was to determine the nurses self-reported confidence level with the SI screening process. A nurse-led implementation team applied rapid Plan-Do-Study-Act (PDSA) cycles to systematically implement an evidence-informed, validated SI screening tool to patients at every clinic and telehealth visit. All patients were provided with information on mental health resources, regardless of screening outcome. Outcomes from this project demonstrated an 11.4% improvement in completed SI screening over the 6-week implementation period. A confidential survey of clinic nurses revealed high levels of comfort with asking and documenting SI screening. Findings from this initiative suggested routine screening for SI is an achievable outcome for outpatient oncology clinics.
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Keywords
suicidal ideation, screening, oncology, quality improvement, ambulatory setting