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You may not yet feel comfortable making these decisions and managing the risk of making the wrong call. It's common to have anxiety around risk management. One way to mitigate risk is to properly document your interviews with patients. Per the last step of the SAFE-T framework, "document your risk assessment, rationale, intervention, and follow-up."

Some tips for effective risk management documentation are:

• If not using electronic records, make sure your notes are legible
• Add your notes in real time, by the end of your shift
• Use only approved abbreviations if you use them at all
• Do not alter previous content, including dates and times
• If you add new content, mark it with the date and time
• Fully explain your thought process, including how you came to the treatment and management decisions you made, and whether or not attempts to contact family or caregivers have been made
• And, if you consulted with other providers in arriving at your decisions, include these individuals' names, when you spoke with them, and their opinions of the case.

Every patient's situation is different, but having more knowledge about warning signs, communication techniques, screening toolkits, referrals, and brief interventions will continue to help you better recognize suicide and substance abuse risk here in the E.D.

Some at-risk patients are easier to recognize and screen than others, and some are easier to motivate to make a change. And remember, because every patient is different, you'll always need to rely on your intuition and past experiences in addition to the screening tools we talked about in this course. You won't reach every at-risk patient who comes into your E.D., but you can help some, and, as an E.D. clinician, you can have an important impact on their lives.

The next four pages contain a review of the techniques and toolkits we've learned today.

Thanks for your interest in this topic and best of luck as you put these techniques into practice with your patients!