Medical Construction & Design

MAR-APR 2018

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MCDM AG.COM | M A RCH /A PR IL 2018 | Medical Construction & Design 47 Ligature-resistant vs. ligature-free The panel recommended the term "ligature-resistant" rather than the term "ligature-free" because it did not think it possible to remove all the potential ligature risks. The panel also defi ned the term ligature-resistant: "Without points where a cord, rope, bedsheet, or other fabric/ material can be looped or tied to create a sustainable point of attachment that may result in self-harm or loss of life." Areas that defi ned that need to be ligature-resis- tant include patient rooms and bathrooms, corridors and common patient care areas. Corridors and common patient care areas Areas that have an unobstructed view from the nurse station (so that a patient attempt at self-harm can be easily seen and inter- rupted) and areas behind self-closing/self- locking doors do not need to be ligature- resistant and will not be cited for risks. Patient toilet room doors The transition zone between patient rooms and patient bathrooms must be ligature- free or ligature-resistant. Feedback from several facilities is that this has been a frequently cited issue. The report suggests several examples of acceptable solutions that include remov- ing the bathroom door, use of soft suicide prevention (foam) door, top-of-door alarm system and using a specially engineered door with a sloped top. Another potential solution might be to lock the toilet room door denying access unless staff is pres- ent. This solution still requires the door and hardware are ligature-resistant in the closed arrangement. Patient room doors to the corridor Doors between patient rooms and cor- ridors must contain ligature-resistant hardware, which includes, but may not be limited to, hinges, handles and locking mechanisms. The expert panel recognized there is some potential ligature risk at the top of doors, but facilities are not required to have risk-mitigation devices installed at the top of corridor doors to decrease the chance that doors will be used as a ligature attach- ment point. However, facilities should note this on environmental risk assessments and describe mitigation strategies (e.g., appropriate rounding/monitoring by staff , requiring that doors be left open during certain hours, etc.). Ceilings All patient rooms and bathrooms must have a solid ceiling. Drop (or lay-in) ceilings can be used in hallways and common patient care areas as long as all aspects of the cor- ridor are fully visible to staff and there are no objects that patients could easily use to climb up to the drop ceiling, remove a panel and gain access to ligature risk points in the space above the drop ceiling. Drop ceilings in areas not fully visible to staff (for example, a right-angle curve of a corridor) or for which it is possible that patients could easily move objects to access the area above the drop ceiling should be noted on the risk assessment and have an appropriate mitigation plan. Mitigation strategies for existing drop ceilings in these areas might include using tile retention clips, installing motion sen- sors to sense tampering with ceilings or using another comparable harm-resistive arrangement. Patient bed type The medical needs and a patients' risk for suicide should be carefully assessed and balanced to determine the optimal type of patient bed required to meet both medical and psychiatric needs. Organizations must have appropriate mitigation plans and safety precautions for patients who require medical beds with ligature points. Patient toilets The expert panelists concluded that standard toilet seats with a hinged seat and lid do not pose a signifi cant risk for suicide attempts or self-harm. While some facilities have been cited for toilet seats over the past several months, the report suggests this should not be cited during future surveys and facilities do not need to list this on their risk assessment. The safety of patients and staff is very important but so are environments designed for de-escalation. In the past 10- 15 years, organizations have shifted their strategy, elevating dignity and care to sit side-by-side safety. More than an anti- harm strategy, they are taking a human- centered safety focus in demonstrating eff ective outcomes and breaking the stigma around mental health treatment. Scott Holmes, RA, ACHA, LEED AP, is associate principal at BWBR Architects. Below: Under the revised guidance from The Joint Commission, drop or lay-in ceilings can be used in hallways and common patient areas if there is an unobstructed view from the nurse station. > Standard toilets with a hinged seat and lid do not pose a signifi cant risk for suicide attempts or self-harm and should not be cited in future surveys. 360 o Recommended viewing angle for observations of patients with serious suicidal ideation — The Joint Commission 4 Number of areas that must be ligature-resistant in inpatient psychiatric units. Areas are patient rooms, patient bathrooms, corridors and common patient areas. — The Joint Commission

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