Increasing Clinicians’ Perceived Knowledge and Confidence of Intranasal and Intramuscular Ketamine for Acute Suicidality

Abstract

Background: Suicide remains among the top ten causes of death in the United States and continues to rise in Maricopa County, where rates increased 17.5% from 2022 to 2023 (Arizona Suicide Prevention Coalition, 2024; Mann et al., 2021). Ketamine demonstrates rapid anti-suicidal effects within hours when administered intranasally or intramuscularly, making it a promising crisis intervention (Fountoulakis et al., 2025; Kumari et al., 2024). Despite its efficacy, many clinicians lack familiarity with safe dosing and monitoring protocols, limiting its integration into behavioral health practice (Ilg et al., 2024; Strayer, 2024).Purpose: This project aimed to increase outpatient behavioral health clinicians’ perceived knowledge and confidence in using intranasal (IN) and intramuscular (IM) ketamine therapy for the treatment of acute suicidality in adults in outpatient and crisis settings (Bell et al., 2024; Ilg et al., 2024). Methods: Two clinicians participated in this quality improvement project. Participant demographics were collected in REDCap, followed by completion of a pre-survey. A concise, evidence-based educational handout was then reviewed at the participant’s own pace, immediately followed by a post-survey. Pre- and post-survey results were compared descriptively, and mean scores were summarized and displayed in a grouped bar chart. Results: There was an overall increase in mean scores for both perceived knowledge and confidence from the pre-survey to the post-survey. Both clinicians correctly identified the monitoring schedule and demonstrated accurate knowledge of the C-SSRS item on both surveys, consistent with their prior familiarity and clinical experience. Conclusions: Findings suggest that a brief, targeted educational intervention improved clinicians’ perceived knowledge and confidence regarding IN/IM ketamine protocols. Although limited by a small sample size, the results support the use of concise, evidence-based education as a practical strategy to enhance clinical preparedness in crisis settings. Future quality-improvement projects should expand participation, include follow-up assessments, and examine operational readiness for implementation.