Improving the quality of initial management of self harm and suicide patients in A+E at the James Paget Hospital.

Our objective was to improve the initial management and documentation of suicide risk assessment in the notes of patients attending A+E with a suicide attempt or self harm. An initial audit was carried out in 2012 looking at the notes of 50 patients who attended the James Paget Hospital accident and emergency (A+E) department following a suicide attempt or self harm episode. Compliance to the NICE guidelines on the initial management of self harm was assessed and was found to be low in certain areas. A significant number of these patients are discharged without evidence of a satisfactory suicide risk assessment being documented. This is dangerous practice for the patients and puts the doctor at risk medico-legally. A number of interventions were introduced to raise compliance to the NICE guidelines. These changes included adaptation to the self harm pro-forma to better conform to the NICE guidelines, departmental teaching sessions, and posters of the pro-forma put up in A+E at the doctors stations. In addition, a "see and greet" nurse was involved in the triage and administration of activated charcoal. The audit was repeated in 2013 and 2014. It was found that the interventions led to an increase in compliance to the NICE guidelines and better documentation in the notes of patients who present with a suicide attempt or self harm episode.