Medical Construction & Design

MAR-APR 2018

Medical Construction & Design (MCD) is the industry's leading source for news and information and reaches all disciplines involved in the healthcare construction and design process.

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46 Medical Construction & Design | M A RCH /A PR IL 2018 | MCDM AG.COM BY SCOTT HOLMES Between 2010 and 2014, The Joint Commission received almost 1,100 reports of suicides occurring in healthcare settings. The reports paralleled a trend that now puts suicide as the 10th leading cause of death in the United States, according to the Centers for Disease Control and Prevention. The issue is nothing new for TJC. For 30 years, TJC surveyors have worked with organizations to help improve the safety of facilities and prevent suicides. However, an analysis of the continued reports of suicide found that organizations were non-compliant in conducting a risk assessment that identifi es specifi c patient characteristics and environmental features related to suicide risk. In response, a directive was issued in February 2017 that required hospital surveyors to cite all potential ligature risks regardless of the size of the risk or patient acuity levels. Items ranging from bathroom doors and toilet seats to door handles that previously fell within safety guidelines and were not cited as issues were now being scored, often under EC.02.06.01 EP 1 or EC.02.01.01 EP 3. The directive led to unrealistic expectations. For example, if an organization was scored for hinges and locksets that posed a ligature risk, based on required door preparation, that likely meant a complete replacement of doors and hardware. Organizations that do not have this project in progress when TJC walks through are unlikely to be able to get it designed and implemented in the 60-day Evidence of Standards Compliance timeline under normal circumstances. After months of discussions with the American Hospital Association, National Association of Psychiatric Health Systems and other healthcare associations, Centers for Medicare and Medicaid Services de- cided to reevaluate the approach to surveys for ligature risk. The Joint Commission as- sembled a panel including representatives from provider organizations, experts in behavioral design and suicide prevention, Joint Commission surveyors and represen- tatives from CMS. Last fall, The Joint Commission issued a special report intended to provide guid- ance for providers and surveyors on poten- tial hazards in healthcare settings (the full report, Special Report: Suicide Prevention in Health Care Settings 10/25/2017, can be found on The Joint Commission's website). In general, the consensus of the group stated that "healthcare organizations should focus as much on staff training and monitoring compliance with protocols as they do on detecting and correcting spe- cifi c environmental hazards." In addition, though, it also had recommendations to ad- dress those hazards: 1,100 Reports of suicides occurring in healthcare settings between 2010 and 2014 — The Joint Commission From top: The Joint Commission expert panel cited patient rooms and patient bathrooms with solid ceilings and ligature-resistant features, such as tear-away privacy curtains to bathrooms, as safe for patients. Soft panel doors or specially engineered sloped doors also provide ligature-resistant alternatives and promote patient dignity. > Ligature-resistant hardware for doors has improved both the safety and aesthetics of patient spaces. 10 Th Suicide is 10th leading cause of death in the U.S. — Centers for Disease Control and Prevention Specialty Spaces S ISSUE FOCUS SUICIDE PREVENTION IN BEHAVIORAL HEALTHCARE SPACES Updated The Joint Commission guidance clarifi es issues on anti-ligature scores BY THE NUMBERS

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