Safe rooms for suicidal patients

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Editor's note: The following is a free excerpt from The Compliance Guide to The Joint Commission’s Patient Safety Systems Chapter. Click here for more information or to order.

A safe, secure environment is critical in terms of a patient safety system of care. Under EC.02.01.01, EP 1, the hospital must proactively find and mitigate risks, including security and safety risks, related to the physical environment that might impact all who come to their facility, inclusive of patients,visitors, and staff.

In terms of ensuring a safe environment for the behavioral health patient population, consider the risk factors that pose a threat to this population. The most common methods of injury and/or harm for this population in hospitals are hanging (i.e., any solid object, such as a nonbreakaway shower head, or cord that can support the “drop weight” of a patient), strangulation (i.e., any object that protrudes from the wall and can support as little as 5–10 pounds of weight, such as a towel bar, faucet handles, open grab bars, soap dispenser, or exposed pipes), suffocation (i.e., plastic trash can liners), and jumping.

Therefore, the most appropriate way to mitigate the risk of harm, whether in an ED or an inpatient care unit (behavioral health unit or inpatient nursing unit), is to remove, to the greatest extent possible, these risk factors that can be used to cause injury to self or possibly even others. Placing patients in an environment where there is opportunity to allow this at-risk population to attempt self-harm or provide them with the means/tools to harm others needs to be carefully considered.

An environment where suicide risk reduction strategies have been implemented can delay spontaneous impulses and allows staff an opportunity to identify an impending crisis, to use de-escalation techniques to reduce the risk of a crisis, and intervene with the most appropriate course of action as indicated. With that said, it is unrealistic in today’s healthcare facility with aging buildings and with how rooms have been constructed to expect to create a complete risk-free environment. Thus, the initial and ongoing environmental risk assessment process becomes even more critical.

This can include moving the patient to a room closest to the nurses’ station for close observation or to a “safe room” that has been constructed specifically for behavioral health patient management and implementing a process of close monitoring, such as 15-minute visual checks. Absent a “safe room,” another way to offset the environmental risk is to implement interim safety measures within the environment for patients who have been assessed as being at risk, such as removing all items from the patient’s room that could be used to harm the patient or others (e.g., IV poles and tubing, mobile carts and trays, monitors, and any items that can be removed from the room, including patient belongings, should be removed from the room and secured) and through the use of 1:1 observation and management, with trained, competent sitters.

Editor's note: This is a free excerpt from The Compliance Guide to The Joint Commission’s Patient Safety Systems Chapter. Click here for more information or to order.