Building a culture of suicide prevention and care: implementation of an evidence-based guideline of the Registered Nurses’ Association of Ontario in a Chilean occupational hospital

We aimed to describe the implementation process and provide a baseline characterization of suicidal behavior during the first year of implementing the Registered Nurses’ Association of Ontario (RNAO) Best Practice Guideline (BPG) for suicide prevention in a tertiary occupational hospital in Santiago, Chile. Cross-sectional descriptive study guided by the Knowledge-to-Action (KTA) framework. The implementation process included: 1) assessment of the local context; 2) adaptation of 26 RNAO BPG recommendations through the first four phases of the KTA cycle; and 3) use of institutional data from April 2024 to April 2025 to establish a baseline of suicidal behavior. Data sources included Emergency Department (ED) consultations, hospital admissions, liaison psychiatry referrals, patient safety reports, and staff training records. Data were analyzed using descriptive statistics. The preliminary assessment identified variable levels of compliance with the RNAO BPG recommendations, with 9 fully met, 12 partially met, and 4 unmet. Contextual analysis revealed key barriers and facilitators at the individual, team, and organizational levels, and identified priority stakeholders. Based on these findings, context-adapted strategies were developed, including protocol standardization, staff training, structured referral pathways, and environmental safety measures. Institutional data showed 7,936 ED consultations, of which 577 (7.3%) involved suicidal behavior. Among 368 admitted patients with primary mental health diagnoses, 336 (91.3%) were linked to suicide risk. Liaison psychiatry documented 7 cases from medical-surgical wards, while patient safety records identified three suicide-related sentinel events associated with mild to moderate harm. Implementation demonstrated that evidence-based nursing, guided by the KTA framework, supports standardized detection and management of suicide risk. These findings provide an initial characterization of suicidal behavior in an occupational health setting and underscore the importance of context-adapted strategies, continuous training, and institutional cultural change to support implementation.