• Announcements

    • Gurpal

      New question bank for paper B   05/11/18

      Please see the link below for a new question bank: http://www.superegocafe.com/online-courses/mrcpsych-paper-b-multiple-choice-question-bank/  
Sign in to follow this  
Followers 0
blob

suicide

10 posts in this topic

you are contacted by the senior nurse on the psych unit as she cannot get hold of the SHO. There has been a suicide on the ward- how do u manage the situation.

Share this post


Link to post
Share on other sites

Issues:

Completed Suicide

Attempted suicide

Anxious relatives, staff

Trust policies in case of completed suicide.

If it is completed suicide (I presume it is)

Emergency, priority, attend to ward immediately, Make sure your own safety, Take the patient to a place of safety on the ward if possible , remove ligature from neck if it was hanging, ABC of life, Attempt CPR (ask staff to call ambulance), if death has occurred, examine signs of death, document death.

Find out from nursing staff and document the circumstances and method used for death during which it happened. The death certificate is to be completed and signed should state when death was declared. Any other documents to be filled or informing seniors (consultants and Managers)to be done (as per the trust policies).

Inform the coroner (or via the police). Speak to the relatives and explain with the help of senior nurse on the ward.

Obviously the body is taken over to mortuary for Autopsy if it is a suicide.

Post incident review and debriefing.

If it is attempted suicide, find the method used and get medical help before psychiatric management. One to one observations until review of plan of management.

In reality this is what I plan to do. I would like to know if anyone thought anything else.

Share this post


Link to post
Share on other sites

well done

did this with my consultant today (part 2 examiner) who pretty much said same thing

only issues were what u would tell other patients, and how u wud manage them

Share this post


Link to post
Share on other sites

hey vijj

i am not sure of what are the ploicies regarding signing of death certificate

i think the last dr to treat the patient will have that duty

againg lot of doubts regarding informing the coroner

Share this post


Link to post
Share on other sites

start by saying 'this is obviously a distressing situation for all concerned'.

BEFORE attending the ward

clarify the following with the senior nurse:

has suicide been confirmed?

wat rescusitative measures ave been implemented?CPR?

has the pt been taken to A/E?ambulance called?

especially because she cldn't reach the SHO,the option of A/E is crucial here.

when ON the ward

issues:

initial discussion with nurse-in-charge and duty manager

ask for copy of a serious incident policy

informing relatives/pt's RMO/coroner/POLICE/senior hospital management.

general support for other pts and STAFF.

Share this post


Link to post
Share on other sites

think other important issues that you have to address are the impact of this incident on other patients becoming more unwell and traumatized specially those who were close to the patients and those who witnessed the incidence also the staff member who was allocated to that patient .

you need to inform the police.

someone will loss his job because of this incident.

Share this post


Link to post
Share on other sites

Can you issue a death certificate if it is a suicide, what do you put down for the cause of death?

I thought death certificate could only be issued after the post mordem?

Can someone clarify this please?

Share this post


Link to post
Share on other sites

Hi ,wonderwhy.

If it is completed suicide (I presume it is)

Emergency, priority, attend to ward immediately, Make sure your own safety, Take the patient to a place of safety on the ward if possible , remove ligature from neck if it was hanging, ABC of life, Attempt CPR (ask staff to call ambulance), if death has occurred, examine signs of death, document death.

Are we supose to do this ie remove ligature or this need to be taken as evidence before removing it?

Share this post


Link to post
Share on other sites

Presumably the big rope shaped bruise and trauma to the airways, coupled with eyewitness reports would be enough for the coroner (they are trained in this sort of thing after all). Don't get hung up (excuse the pun) on minutiae. It would not matter for the purposes of the PMP if you mention removing the ligature or not. If you do mention it and are unsure then it invites the examiners to say 'Are you certain you would remove the ligature, Doctor?' and then you are stuck.

The key things in this PMP have all been mentioned above.

Share this post


Link to post
Share on other sites
Sign in to follow this  
Followers 0