Which action best addresses suicide risk in a patient with expressed intent?

• A. Refer to psychiatric consult only
• B. Provide supportive counseling and document
• C. Initiate restraints without assessment
• D. Assess for suicide risk and implement safety measures, including one-to-one observation

Answer: (D)

When someone shows intent to harm themselves, the immediate priority is to assess the level of risk and enact safety measures right away. Gather essential risk information: exact plan, timing, means available, prior attempts, and any protective factors or supports. This assessment guides what to do next, but safety shouldn't wait for it.

Implement safety measures based on the risk findings: ensure the patient is in a safe environment, remove or secure potential means, and provide constant observation (one-to-one) as needed to prevent acts of self-harm. Keep the patient connected with a trusted staff member, maintain open, nonjudgmental communication, and document the plan and observations. Involve the mental health team for further evaluation and treatment decisions as appropriate.

Referencing psychiatric consultation alone delays immediate safety actions. Providing supportive counseling and documenting doesn’t address the imminent risk. Initiating restraints without an assessment is inappropriate and unsafe. The best approach combines a thorough risk assessment with concrete safety measures to protect the patient.