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					Jan-11




         Preventing Suicide: A Toolkit for Emergency Departments

                                   CHECKLIST
                               Emergency Department



                    Trust:                [Insert trust name]
                    Trust Address:        [Insert trust address]
                    Completed by:         [Insert name]
                    Completion Date:      [Insert date]




                                    c81bb433-b8ec-474f-aa38-9c38279c2c89.xlsx
Preventing Suicide Audit Tool




                                    PREVENTING SUICIDE AUDIT - PERFORMANCE SUMMARY


                                                                     Summary Bar Chart


                    100%


                    90%


                    80%


                    70%


                    60%
       Compliance




                    50%


                    40%


                    30%


                    20%


                    10%


                     0%
                           Consent & Capacity      Intervention & Care      Suicide Prevention          Family/Carers    Follow up care
                                                                                 Standard




                                                                  Performance Dashboard
    Consent & Capacity           Intervention & Care         Suicide Prevention              Family/Carers              Follow up care                  Std_1     Std_2     Std_3     Std_4     Std_5
           1.1                           2.1                         3.1                          4.1                        6.1                        No Data   No Data   No Data   No Data   No Data
           1.2                           2.2                         3.2                                                     6.2                        No Data   No Data   No Data             No Data
           1.3                           2.3                         3.3                                                                                No Data   No Data   No Data
                                                                     3.4                                                                                                    No Data
                                                                     3.5                                                                                                    No Data
                                                                     3.6                                                                                                    No Data

                                                                                  Key:
                                           Green       Standard sub criterion met in 100% of audit sample
                                          Amber        Standard sub criterion met in 50-99% of audit sample
                                           Red         Standard sub criterion met in less than 50% of audit sample                                      #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!
                                           Blue        No relevant data was entered for this standard criterion




                                                                                                                                          Page 2 of 3
                                                                                            Suicide Audit Tool - A Checklist for Department Managers


Please state 'Yes', 'No', or 'Not applicable' in each of the following boxes. If your answer is 'Not applicable' please state why in the comments section.

Audit Question                                                                                          Patient                                              Comments
PATIENT RECORDS                                                                        1   2              3                 4                5                          Yes   No     Yes%
           If the patient was deemed not to have capacity to
   Consent & Capacity




       1.1 consent to treatment were the reasons for this
           recorded in the clinical record?                                                                                                                               0    0   No Data
           Is it recorded that actions taken were in the
       1.2 patient's best interests?
                                                                                                                                                                          0    0   No Data
                             Is there evidence that all treatments were
                         1.3 explained to the patient unless being delivered in
                             an emergency?                                                                                                                                0    0   No Data
                             Are there examples of specific personal, cultural,
                         2.1 religious or other factors being assessed?
   Intervention & Care




                                                                                                                                                                          0    0   No Data
                             If it is not possible to offer a choice of male or
                             female staff for assessment and treatment, is there
                         2.2 evidence that the reasons for this have been
                             explained to the patient?                                                                                                                    0    0   No Data
                             Are there examples that patients' needs regarding
                             gender specific care has been assessed,
                         2.3
                             documented and met in clinical records?
                                                                                                                                                                          0    0   No Data
                         3.1 Are risk assessments present?                                                                                                                0    0   No Data
                             Is there documentation that a copy of the
                         3.2 assessment information has been passed to the
                                                                                                                                                                          0    0   No Data
   Suicide Prevention




                             patient's GP?
                             Is there evidence that patients have been involved
                         3.3 in the formulation of the assessment, treatment
                             and aftercare plan?                                                                                                                          0    0   No Data

                         3.4 Is the assessment of needs clearly recorded in the
                             patient record?                                                                                                                              0    0   No Data

                         3.5 Is the assessment of current and future risk
                             recorded in the patient record?                                                                                                              0    0   No Data
                             Is the treatment and/or referral plan clearly
                         3.6 recorded in the patient record?
                                                                                                                                                                          0    0   No Data
Family/Carer




                             Has consent been obtained to involve
                         4.1 family/carers in gathering information/contributing
     s




                             to assessment of a patient who has self-harmed?
                                                                                                                                                                          0    0   No Data
                             Is there evidence that the patient has been given
Follow up




                         6.1 information about what to do in the event of a
  care




                             psychiatric emergency?                                                                                                                       0    0   No Data
                             If relevant, is the rationale for decision to discharge
                         6.2 without follow up care included in the clinical
                             notes?                                                                                                                                       0    0   No Data


                              Yes
                              No
                              Not applicable

				
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