Healthcare settings have been recognized by the National Action Alliance for Suicide Prevention as ideal opportunities for suicide prevention. In the United States, intentional (suicidal) poisoning is responsible for 67% of non-fatal suicidal injuries and 13% of suicide deaths. Medications prescribed in healthcare settings are likely the source in most intentional poisonings, specifically opioids, psychotropics and hypnotics. This means overdose prevention should be addressed at the time of prescribing. To prevent intentional poisoning, we propose to develop a medication safety plan that is brief (5-10 minutes) and easily completed in collaboration with any type of health provider (e.g., primary care nurse, pharmacist, or mental health clinician). The medication safety plan will involve increasing awareness of warning signs or triggers for exacerbation of suicide risk and/or mental health distress so patients know when to enact the plan, followed by identifying specific actions to decrease access to medications (e.g., disposing of old medications, locking-up medications, identifying a support person to help manage medications). Low-risk patients in outpatient health settings will be targeted since there is a paucity of interventions that directly addresses suicidal behavior for this group, especially women "“ who have the highest risk of intentional poisoning.
Human-centered design with input from both patient and provider stakeholders will inform the development of the intervention and identification of implementation strategies needed for adoption and uptake of the intervention in the healthcare setting. Designing for translation to the healthcare setting from the start is essential to address the growing research to practice gap for most evidence-based interventions. The study setting is Kaiser Permanente Colorado "“ a large integrated health care system with robust uptake of depression and suicide screening instruments during health visits that will facilitate identification of low-risk individuals (i.e., ideation only).
The goals of this project will be achieved through two aims. The first aim will develop a brief medication safety plan to prevent intentional poisoning using human-centered design that is informed by adult patients with lived experienced of intentional poisoning and providers from multiple departments (e.g., pharmacy, behavioral health, primary care) who treat these patients. The second aim will pilot test the medication safety plan with 30 patients and determine attitudes, subjective/social norms, perceived behavioral control, and behavioral intention to use the plan with a survey. The expected outcomes of aims 1 and 2 are to develop a medication safety plan that 1.) is acceptable to providers using specific healthcare system implementation strategies identified through provider interviews and 2.) promotes favorable patient attitudes, subjection/social norms, perceived behavioral control, and most importantly, behavioral intention towards using the medication safety plan when suicide risk increases. The future goal is to test the medication safety plan developed here in a larger study to examine impacts on suicidal behavior. This study will serve as a foundation for the development of the intervention, identification of implementation strategies that need to be incorporated as part of the intervention package, and the methods for evaluation (e.g., survey development and testing).
