Review panel recommends 9 changes for NH hospital after ex-patient's suicide
CONCORD — A team that reviewed the discharge of a New Hampshire Hospital patient who committed suicide hours later has made nine recommendations, some of which are already being implemented.
The team was led by a Vermont psychiatrist and included members of New Hampshire's legal and law enforcement committee. Gov. Chris Sununu said Tuesday the state has begun taking several steps based on the team's recommendations including strengthening communication and collaboration between the hospital and community mental health centers, improving suicide risk training for nursing staff and requiring additional review of discharge plans when patients, guardians or staff raise concerns.
The team also recommended reassigning staff to provide continuity of care across multiple admissions and reviewing whether mental health centers should have a greater role in the treatment and discharge planning process.
1. Reevaluate and revise, as needed, collaboration and communication processes between NHH and the community mental health centers. Provide training to staff regarding the need for meaningful collaboration and communication. Consider whether the LEAN program would be an effective tool for implementation of this recommendation. Evaluate NHH policies and procedures to insure full alignment with the transition provisions and “in reach activities” as outlined in the Amanda D. Settlement Agreement. Provide training to NHH staff on the meaningful implementation of the NHH Transition/Discharge Planning policy and any other related policies.
2. Establish a written policy for the method a patient, guardian, community mental health center, or NHH staff member can use to raise concerns with the treatment or discharge plan of a patient. Provide training to staff on this policy and how to recognize when this policy is triggered. Provide information to community mental health centers, patients, and guardians on this policy.
3. Implement existing Administrative Review Committee (ARC) policy regarding the types of cases referred for review by the ARC. Provide training to staff on the policy and other available resources, such as clinical case conferences and the central team to address barriers to discharge. Review and revise, as appropriate, policies regarding patient cases requiring review of the treatment and discharge plan by the ARC or any other external or peer review team. Factors that may qualify for review include multiple and frequent hospitalizations, multiple medications, and inconsistency and/or disagreement in diagnoses.
4. Restructure the assignment of social workers, nursing staff, and/or attending psychiatrist to provide continuity of care with the same providers across multiple admissions.
5. Review whether the community mental health centers should have a greater role in the treatment and discharge planning process since they provide continuity of care to the patient
6. Establish individual and confidential support options and a facilitated peer support program for staff that does not involve direct supervisors. Consider whether participation at a regular interval (monthly or quarterly) in a peer support program should be mandatory.
7. Establish a policy for determining when to obtain treatment records from outside providers and the most expeditious manner to obtain the records.
8. Evaluate whether a policy should be developed and implemented for determining when a patient is appropriate for a short admission to NHH. Consider whether factors such as recent admissions, length of time outside of the hospital, and history with the community providers are relevant to determining whether a short admission is appropriate. Consideration should also be given to how short admissions are integrated with existing transition/discharge policies and the Amanda D. transition provisions.
9. Evaluate whether there is adequate competency-based training for suicide risk assessment and prevention and whether such training is based upon best practices. If not, take appropriate remedial measures.