[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Mental health and psychiatric nursing](https://durgical.com/en/nursing/areas/mental-health/) › Suicide risk: screening, a safety plan, observation levels and a safe environment # 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. Updated Nov 13, 2026 ## Key points - Ask directly: «Are you thinking about killing yourself?» It does not increase the risk. - Assess ideation, plan, intent, access to means, previous attempts, risk factors and protective factors. - Remove means (cords, belts, sharp objects, medicines), check belongings and visitors' items, remove anchor points. - Follow the ordered observation level exactly; vary the times of rounds so they are not predictable. - The safety plan is brief, written in the patient's own words and lists coping strategies, people and services to contact. - Risk is high after discharge: give written follow-up and crisis contacts; in Colombia, notify an attempt to SIVIGILA (event 356). ## 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. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/suicide-risk-screening-a-safety-plan-observation-levels-and-a-safe-environment/) ## Elsewhere in DurgiPedia - [Crisis intervention and supportive psychotherapy](https://durgical.com/en/behavioral-science/crisis-intervention-and-supportive-psychotherapy/) - [Professional secrecy and confidentiality](https://durgical.com/en/medical-ethics/professional-secrecy-and-confidentiality/) ## Connections ## Related 3 - [Mental-health nursing assessment: history, the mental status from the nursing side and risk screening](https://durgical.com/en/nursing/mental-health-nursing-assessment-history-the-mental-status-from-the-nursing-side/) - [Caring for a person with depression: safety, self-care, activity and hope](https://durgical.com/en/nursing/caring-for-a-person-with-depression-safety-self-care-activity-and-hope/) - [Nursing documentation: principles, formats and legal value](https://durgical.com/en/nursing/nursing-documentation-principles-formats-and-legal-value/) ## Related conditions 2 - [Suicidal behaviour and suicide risk](https://durgical.com/en/conditions/suicidal-behaviour-and-suicide-risk/) - [Major depressive disorder](https://durgical.com/en/conditions/major-depressive-disorder/) [← All of nursing](https://durgical.com/en/nursing/) 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](https://med.libretexts.org/Bookshelves/Nursing/Nursing%3A_Mental_Health_and_Community_Concepts_(OpenRN)/01%3A_Foundational_Mental_Health_Concepts/1.06%3A_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)](https://med.libretexts.org/Bookshelves/Nursing/Nursing%3A_Mental_Health_and_Community_Concepts_(OpenRN)/04%3A_Application_of_the_Nursing_Process_to_Mental_Health_Care/4.09%3A_Implementation) (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2022); [Suicide (fact sheet)](https://www.who.int/news-room/fact-sheets/detail/suicide) (World Health Organization (WHO), 2026); [Protocolo de vigilancia en salud pública: Intento de suicidio (código 356), versión 6](https://www.ins.gov.co/buscador-eventos/Lineamientos/Pro_Intento%20de%20Suicidio%202025.pdf) (Instituto Nacional de Salud (INS), Colombia, 2025). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/suicide-risk-screening-a-safety-plan-observation-levels-and-a-safe-environment/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/suicide-risk-screening-a-safety-plan-observation-levels-and-a-safe-environment/