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Compliance rate of adhering with policies and procedures for care of patients at risk for suicide and self-harm
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Indicator Name:Compliance rate of adhering with policies and procedures for care of patients at risk for suicide and self-harmJANFEBMARAPRMAYJUNJULAUGSEPOCTNOVDEC
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Numerator: No of patients treated with self harm/suicidal risk adhering with the hospital policies, protocols, & environment safety measures implementedNumerator
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Denominator:Total No of patients with self harm/suicidal risk treated/admitted in the monthDenominator
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RationaleEnsures adherence to protocols for managing high-risk patients, minimizing incidents of self-harm or suicide.Rate#DIV/0!#DIV/0!#DIV/0!#DIV/0!#DIV/0!#DIV/0!#DIV/0!#DIV/0!#DIV/0!#DIV/0!#DIV/0!#DIV/0!
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Inclusion CriteriaAll patients who are at risk for suicide or self harm Target-100%100%100%100%100%100%100%100%100%100%100%100%100%
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Exclusion CriteriaPatients who have no significant findings during the suicide/self harm screening
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Indicator Owner: Head Nurse
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Selection criteria:√High Risk □ High Volume □IPSG √ Problem Prone □High Cost
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□ Contract Monitoring □ Regulatory Requirement
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□ Others: Accreditation requirement
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Type of Indicator:□ Structure √ Process □ Outcome □ Process & Outcome
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Frequency:√Monthly □ Quarterly □ Bi-Annual □ Annual
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Department/ Unit
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Sample Size: All patients who are positive for Self harm/suicide screening
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Data collection method / Source KPI facilitator will observe all patients in a month who are positive for self harm/suicidal risk, and record in observations into the KPI data collection tool.
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Data methodology:√ Retrospective □ Concurrent
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Unit of MeasurementPercentage
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Target:100%
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Benchmark (If Applicable)
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Data Analysis:
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Common variations
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Action plan:
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