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Mitigating Factors & SRAT

Presented July 2015 by:

Ruth Cangialosi MSN, RN | Clinical Nurse Lead RRCLinden Oaks  |  852 S. West St. Naperville, IL 60540630.646.7320 |www.lindenoaks.org

rcangialosi@edward.org

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Mitigating Factors DefinedThe term ‘mitigating factors’ is a legal term that means, “To lessen in force or intensity”, “to make less severe or painful” (Merriam-Webster, 2014).

• At LOH this term is used synonymously with the term “protective factors”. The term ‘protective factors’ refers to conditions in individuals that increase health and well-being.  

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Mitigating/Protective Factors Include:

• Individual attributes

• Social and economic circumstances.

• Environmental factors (World Health Organization, 2012).

 

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Mitigating factors/Protective factors are “risk reduction factors”.

• Some common examples of mitigating factors/protective factors include:

• Pregnancy

• Employment

• Sense of responsibility to family

• Religious – Strong personal faith

• Living with another person, especially a relative

• Positive social support system

• Patient has insight

• Positive, future oriented (hopeful) (Perlman et al., 2011).

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Mitigating or Precipitating Factor?

• My boyfriend broke up with me. Now I am beginning to realize I don’t deserve to be abused and I want to live.

• I stopped drinking - Although it’s been hard, I see the good times in my life better now

and I want to prove that I can live sober.

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Who do we include mitigating factors on when charting?

• 100 % of our patients who have past or current suicidal ideation.

Information provided by Linden Oaks Marketing & Business Development

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What if the patient is recommended for inpatient admission:

COMPLETE A SRAT!

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What is the SRAT?

The SRAT is a suicide risk assessment tool.

Risk assessment tools are useful in providing additional information to inform the risk assessment interview (Perlman et al., 2011).

If the SRAT tool does NOT contain the mitigating factors line, it is imperative that you ensure this documentation is included elsewhere.

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Step-Up

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To Summarize (part 1):

• All patients receive a suicide risk assessment.

• If they answer ‘yes’ to current or previous suicidal thoughts or intentions, then mitigating factors must be asked and documented, 100% of the time.

• If the doctor recommends the patient for admission to LOH, a SRAT must be completed.

• If the SRAT tool does NOT include the line for mitigating factors, make certain this documentation is present elsewhere in the charting and part of the counselor note.

• If the SRAT tool DOES have the line for mitigating factors, complete that line in the SRAT.

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To Summarize (part 2):

• If the patient is a Step-Up, the suicide risk assessment, including mitigating factors, must (100% of the time) be in the CT note. There is current work being done in EPIC to pull the SRAT and mitigating factors to this note. Until that happens, you will need to ensure that this information is being documented and clearly communicated upon Step-up.

• “While suicide risk assessment instruments and scales are available and important elements of the process, they should never be used alone or as a substitute for a thorough clinical assessment” (Perlman et al., 2011, p. 25).

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1). Staff education beginning July 14, 2015.RRC RN’s & Counselors, Off-Site Counselors, Nursing Supervisors, CRT’s, Linden Oaks @ Elmhurst

Counselors, and other staff who float into RRC.By signing the sign in sheet – you are stating that you

understand Mitigating Factors and SRAT’s;

2). Auditing of charts every day to ensure 100% compliance.

3). Individual education for those not completing these 100% of the time.

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References

Merriam-Webster Dictionary. (2014). Retrieved from http://www.merriam webster.com/dictionary

Perlman C.M., Neufeld E., Martin L., Goy M., & Hirdes J.P. (2011). Suicide risk assessment inventory: A resource guide for Canadian Health Care Organizations. Toronto, ON: Ontario Hospital Association and Canadian Patient Safety Institute. Retrieved from

http://www.oha.com/CURRENTISSUES/KEYINITIATIVES/MENTALHEALTH/Pages/SuicideRiskAssessmentGuidebook.aspx#sthash.c2f62ynE.dpuf

Violence Risk Screening -10(V-RISK-10). (2007). Center for Research and Education in Forensic Psychiatry, Oslo,Norway.

World Health Organization. (2012). Risks to mental health: An overview of vulnerabilities and risk factors. Retrieved from http://www.who.int/mental_health/mhgap/risks_to_mental_health_EN_27_08_12.pdf

LOH Policies

LOH CLIN 150: Suicide Risk and PrecautionsLOH CLIN 078: Safety PrecautionsLOH RRC Counselor Job Description

Ruth Cangialosi MSN, RN | Clinical Nurse Lead RRCLinden Oaks  |  852 S. West St. Naperville, IL 60540630.646.7320 |www.lindenoaks.org