Human factors in suicide prevention

Abstract

This article uses a case study to discuss the importance of human factors in maintaining patient safety in the community. Although the case relates to a patient suffering from mental illness, the principles discussed here are transferrable to physical illnesses. This article aims to describe some of these human factors and how they relate to the healthcare setting.

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References

Ahmed

Arora

McKay

Long

Vincent

Kelly

Bowie

(2014) Patient safety skills in primary care: A national survey of GP educators. BMC Family Practice 15(1): 206, doi: 10.1186/s12875-014-0206-5.

BBC News. (2014). Golden Gate Bridge jump survivor Kevin Hines at Belfast conference. Retrieved from www.bbc.co.uk/news/uk-northern-ireland-29995470.

BNF. (2017). Antidepressant drugs (4.3). Retrieved from www.evidence.nhs.uk/formulary/bnf/current/4-central-nervous-system/43-antidepressant-drugs#PHP2349.

Brennan, A., Rahman, S., & Reynolds, H. (2014). Simulation in technical and non-technical medical skills training: Experience from Yorkshire and the Humber. BMJ Careers.

Cole-King

Green

Peake-Jones

Gask

(2011) Suicide mitigation. InnovAiT 4(5): 288–295. doi: 10.1093/innovait/inr018.

Cox

(1991) The structure of employee attitudes to safety: A European example. Work and Stress 5(2): 93–106. doi: 10.1080/02678379108257007.

Department of Transport. (2016). Reported road casualties in Great Britain: Main results 2015. Retrieved from www.gov.uk/government/uploads/system/uploads/attachment_data/file/533293/rrcgb-main-results-2015.pdf.

Dunn

E. J.

Mills

P. D.

Neily

Crittenden

M. D.

Carmack

A. L.

Bagian

J. P.

(2007) Medical team training: Applying crew resource management in the Veterans Health Administration. Joint Commission Journal on Quality and Patient Safety / Joint Commission Resources 33(6): 317–325.

Endsley, M. R. (1999). A taxonomy of situation awareness errors. In M. Endsley (Ed.), Proceedings of the Consequence Systems Surety Conference (pp. 2–9). Retrieved from http://209.238.175.8/Papers/pdf/Sandia99-safety.pdf.

10.

Flin, R., O’Connor, P., & Crichton, M. (2008). Safety at the sharp end: A guide to non-technical skills. In Safety at the sharp end: A guide to non-technical skills (pp. 17–40).

11.

Francis, R. (2013). The Mid Staffordshire NHS Foundation Trust Public Inquiry. Retrieved from http://webarchive.nationalarchives.gov.uk/20150407084003/http://www.midstaffspublicinquiry.com/report.

12.

Haig

K. M.

Sutton

Whittington

(2006) SBAR: A shared mental model for improving communication between clinicians. Joint Commission Journal on Quality and Patient Safety / Joint Commission Resources 32(3): 167–175.

13.

Hines

Cole-King

Blaustein

(2013) Hey kid, are you OK? A story of suicide survived. Advances in Psychiatric Treatment 19(4): 292–294. doi: 10.1192/apt.bp.111.009878.

14.

Intercollegiate Surgical Curriculum Programme. (2012). The non-technical skills for surgeons (NOTSS) system handbook. Retrieved from ww.iscp.ac.uk/static/help/NOTSS_Handbook_2012.pdf.

15.

Jones

D. G.

Endsley

M. R.

(1996) Sources of situation awareness errors in aviation. Aviation Space and Environmental Medicine 67(6): 507–512. doi: 10.1039/c4qo00187g.

16.

Kaiser Foundation Health Plan. (2013). The SBAR tool for communication. Retrieved from http://stateclaims.ie/wp-content/uploads/2013/07/SBARPresentationDeteriorating.pdf.

17.

Klein

J. G.

(2005) Five pitfalls in decisions about diagnosis and prescribing. BMJ: British Medical Journal 330(7494): 781–783. doi: 10.1136/bmj.330.7494.781.

18.

Luoma, J. B., Martin, C. E., & Pearson, J. L. (2002). Contact with mental health and primary care providers before suicide: A review of the evidence. American Journal of Psychiatry. doi: 10.1176/appi.ajp.159.6.909.

19.

Martin, K., McDaid, D., & Parsonage, M. (2011). Mental health promotion and prevention: The economic case. Retrieved from www.lse.ac.uk/businessAndConsultancy/LSEEnterprise/pdf/PSSRUfeb2011.pdf.

20.

Maurino

D. E.

Reason

Johnston

Lee

R. B.

(1998) Beyond aviation human factors: Safety in high technology systems, Aldershot, UK: Avebury Aviation.

21.

NICE. (2014). Bipolar disorder: Assessment and management. Retrieved from www.nice.org.uk/guidance/cg185/resources/bipolar-disorder-assessment-and-management-35109814379461.

22.

Office for National Statistics. (2014). Suicides in the United Kingdom: 2014 registrations. Retrieved from www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2014registrations.

23.

Reason

(1993) The identification of latent organizational failures in complex systems. In: Wise

J. A.

Hopkin

V. D.

Stager

(eds) Verification and validation of complex systems: Human factors issues, Berlin, Heidelberg, Germany: Springerdoi: 10.1007/978-3-662-02933-6_13.

24.

Richardson, W. C., Berwick, D. M., Bisgard, C., Bristow, L., Buck, C. R., Coye, J., Corrigan, J. (2000). To err is human: Building a safer health system. Retrieved from www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx.

25.

Samaritans. (2016). Suicide statistics report 2016. Retrieved from www.samaritans.org/sites/default/files/kcfinder/files/Samaritanssuicidestatisticsreport2016.pdf.

26.

Schaefer

H. G.

Helmreich

R. L.

Scheidegger

(1994) Human factors and safety in emergency medicine. Resuscitation 28(3): 221–225. doi: 10.1016/0300-9572(94)90067-1.

27.

The Health Foundation. (2011). Retrieved from www.nes.scot.nhs.uk/media/2407629/levels_of_harm_in_primary_care.pdf.

28.

Tsang

Majeed

Banarsee

Gnani

Aylin

(2010) Recording of adverse events in English general practice: Analysis of data from electronic patient records. Informatics in Primary Care 18(2): 117–124. Retrieved from www.ncbi.nlm.nih.gov/pubmed/21078234.

29.

UK Government. (2014). Information sharing and suicide prevention: Consensus statement. Retrieved from www.gov.uk/government/uploads/system/uploads/attachment_data/file/271792/Consensus_statement_on_information_sharing.pdf.

30.

Vanderhaegen

(2015) Erik Hollnagel: Safety-I and Safety-II, the past and future of safety management. Cognition, Technology & Work 17(3): 461–464. doi: 10.1007/s10111-015-0345-z.