Suicide Screening – Meeting NPSG 15 Requirements

Standardizing Suicide Screening Tools: Is It a Requirement or Just a Best Practice?

Patient safety is at the core of every hospital’s mission. The Joint Commission’s National Patient Safety Goal (NPSG) 15.01.01 (see NPG.08.01.01 in the 2026 standards) is a critical standard that addresses suicide prevention in healthcare settings. It requires hospitals to have a robust process including a validated screening tool for identifying patients at risk for suicide and to ensure they receive appropriate follow-up care upon discharge.

This can raise a common question for healthcare leaders: Is our hospital required to use the same validated suicide screening tool across all departments, from inpatient units to outpatient clinics?

Are Standardized Suicide Screening Tools a Requirement?

The short answer is: no, it is not an explicit Joint Commission requirement. But, the long answer is that using a uniform, standardized tool is a highly recommended best practice. We usually see the same tool used in an organization which simplifies training and competency. You could use two tools if your clinical content experts document that one is better for an ambulatory environment and a second is better for a protective environment like inpatient. We advise against using different tools for different inpatient units or outpatient clinics. This might give TJC the impression that there is no central guidance or consensus building process.

Compliance and Best Practices Go Hand-In-Hand

When it comes to suicide prevention, meeting the minimum requirement is not enough. The spirit of NPSG 15.01.01 is about creating a safe and consistent process for identifying and helping at-risk individuals. While a uniform tool isn’t explicitly required, it is the most effective way to meet and exceed these standards, simplify your processes, and ultimately, protect your patients.

A standardized validated suicide screening process simplifies training, strengthens your data, and demonstrates a clear, organization-wide commitment to patient safety.

Need Help Navigating Your Joint Commission Compliance?

Patton Healthcare Consulting provides a complete range of Joint Commission and CMS Compliance Assistance and a full range of pre-survey and post survey services.

In fact, we serve more than 400 hospitals, behavioral health care organizations, ambulatory clinics and home care companies nationwide—hospitals ranging from critical access hospitals to the largest health systems. Contact us at (888) PHC-INC1 for more information.