Caring for Suicidal Children in the ED

Emergency lights #5, by DrStarbuck via Flickr

Suicidal children and adolescents are often first seen in EDs. At Children’s Hospital Boston (CHB) recently, a boy we’ll call J.J. was one of them. Still in elementary school, he had just started a new school year. J.J. has Asperger’s syndrome (a disorder on the autism spectrum), and new situations are difficult for him. His classmates were teasing him, and it was escalating: one boy reportedly threatened to kill J.J. for being “weird.” Despite efforts by J.J.’s parents and the school to address the situation, J.J. became increasingly depressed and fearful. As September CE authors Alexis Schmid and colleagues explain,

On the morning of the ED visit, as the family members were starting their day, J.J. had gone into the kitchen, found a butcher knife, and held it to his throat. His mother walked in and saw him. Although J.J. willingly surrendered the knife to her, she said she was “rattled to the core.”

Schmid was the ED nurse on J.J.’s case that day (all three authors work at CHB). In “Care of the Suicidal Pediatric Patient in the ED: A Case Study,” the authors describe the course of J.J.’s care and what they did to keep J.J., his family, and the hospital staff safe as the day progressed. The authors then provide an overview of pediatric suicide and suicide attempts; describe screening, assessment, and interventions used at the hospital; and discuss the nursing implications. The article also offers

• CHB’s Risk of Suicidality Clinical Practice Algorithm, which the hospital developed to ensure evidence-based care supported by best practice guidelines. Based on Joint Commission requirements for patients seeking psychiatric services, the algorithm has two phases, a triage phase and an acute care phase, and is included in the article as a tear-out sheet.
• A look inside CHB’s “Behavioral Health Cabinet.” The cabinet serves as a place to keep copies of relevant hospital policies and procedures, family education materials, restraint resources, and deescalation tools such as age-appropriate art supplies and portable video games.
• A list of resources for families.

For more information on how to care for suicidal children and adolescents in the ED, read the article; as a CE article, it’s free online. And don’t miss our podcast conversation with authors Schmid and Frances Damian.