Suicide risk: screening, a safety plan, observation levels and a safe environment
- Safe practice
Ask directly about suicide, assess the plan and the means, make the setting safe, agree a written safety plan and secure follow-up after discharge.
What it is
Suicide is preventable. The nurse recognises warning signs, screens with a validated tool, contributes to the risk assessment, keeps the environment safe, follows the observation level ordered, documents and communicates the risk, and prepares the discharge with a safety plan and follow-up. Asking directly about suicide does not plant the idea; an appropriate response can save a life. Risk rises with a specific plan, access to a lethal method and previous attempts. In Colombia a suicide attempt is a notifiable public-health event (SIVIGILA event 356, INS protocol 2025): ideation or a plan alone is not notified as an attempt.
What it requires
- Universal screening of patients aged 12 and over in acute care.
- Documentation of the risk level and the plan every shift or more often, as the patient's status requires.
- Strict adherence to institutional policy (for example, one-to-one observation when ordered).
- Clear communication of the risk to the whole team and at every handoff.
Components
- Warning signs: feeling a burden, isolation, hopelessness, feeling trapped, unbearable pain, more substance use, seeking means, talking or posting about dying, making plans.
- Environmental safety: room checks, removal of objects, safe transfers within the hospital.
- Observation: rounds at irregular intervals or continuous one-to-one observation, as ordered.
- Safety plan and follow-up: written plan, crisis contacts, appointment and family involvement.
How it is applied (and why)
- Screen with the validated tool and, if positive, ask about ideation, plan, intent, means and past attempts: risk varies widely.
- Stay with the person or make sure they are with someone in a safe place while help is sought: never leave a high-risk person alone.
- Remove objects that could be used for self-harm and check items brought in: restricting means prevents deaths.
- Apply the observation level ordered, with rounds at varying times: predictable rounds leave gaps.
- Listen without judging and name hope; avoid promises of secrecy: the team must know the risk.
- Build the safety plan with the patient: warning signs, coping steps, people and services; ask where they will keep it.
- Record the risk level and interventions and report them at handoff: everyone must know the plan.
- At discharge, give written follow-up and crisis contacts and involve the family when the patient agrees: the risk is high after discharge.
In nursing practice
- A sudden calm after a period of depression can be a warning sign, not only improvement.
- Hallucinations that order self-harm raise the urgency.
- Non-suicidal self-injury (cutting, burning, hitting) has no intent to die but still needs assessment and care.
- Confidentiality has a limit: risk to life is shared with the team, and the patient is told so.
Common mistakes
- Thinking that asking about suicide will put the idea in the person's head.
- Leaving the patient alone in the bathroom or during transfers when one-to-one observation is ordered.
- Doing rounds at fixed, predictable times.
- Discharging without a safety plan, follow-up appointment or crisis contacts.
Test yourself
Think of the answer, then tap the question to see it.
Does asking a person directly about suicide increase the risk?
No. Asking directly does not put the idea in their head; responding appropriately can help save their life.
Which elements increase the risk of acting on suicidal thoughts?
A specific plan, a lethal method within reach, intent to carry out the plan and previous suicidal or self-harm behaviour.
What should a safety plan contain?
A brief written list, in the patient's own words, of warning signs, coping strategies, people and services to contact in a crisis, plus where the plan will be kept.
In Colombia, is suicidal ideation without an attempt notified as SIVIGILA event 356?
No. The INS case definition excludes ideation or a plan alone; event 356 is a self-inflicted, potentially harmful act with intent to die and a non-fatal outcome.
Elsewhere in DurgiPedia
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Nursing: Mental Health and Community Concepts, 1.6: Establishing safety (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2022); Nursing: Mental Health and Community Concepts, 4.9: Implementation (milieu safety and rounding) (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2022); Suicide (fact sheet) (World Health Organization (WHO), 2026); Protocolo de vigilancia en salud pública: Intento de suicidio (código 356), versión 6 (Instituto Nacional de Salud (INS), Colombia, 2025).
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Representative model, for educational purposes only.