Last month we wrote about the increased emphasis on Joint Commission surveys on the subject of ligature risk. One of the questions we get asked a lot as consultants is: where can I purchase a safer bathroom door, a safer sink, a safer shower head, etc. There are two references we would suggest. The first is titled the Design Guide for the Built Environment. This used to be offered through the NAPHS, but now it is offered free of charge through the Facilities Guideline Institute, or FGI.
You can download a copy of this document from:
A second document you should have is the New York State Office of Mental Health’s Patient Safety Standards, Materials and Systems Guidelines. OMH is probably the largest state provider of psychiatric services and the regulating body for mental health services provided by acute care hospitals in NY. This document can be downloaded from:
The NYS OMH document identifies fixtures and equipment that have been evaluated by the regulatory body as approved for use in NYS and includes pictures of many of those not approved for use with meaningful advice on those not approved which is often valuable for evaluating alternatives.
Both documents provide pictures of the fixtures and furniture they deem better alternatives. Fortunately for patients, and unfortunately for those involved in facilities design, newer and better alternatives become available each year. So, as you build or renovate you will never really be done, as equipment that seems a better alternative in 2017, may not be the best in 2020. We would encourage you to keep up with both of these resources as each prepares an annual update.
In addition, our consulting clients should review our environmental risk assessment tool. Our tool identifies many of the usual hazards present in the behavioral health environment and in an Excel format allows the user to add or delete rows for items we did not list or items you don’t have. Each potential hazard gets evaluated on a 3-point scale for each of three factors, probability of use, criticality of use and detectability, or your ability to see someone attempting to harm themselves with an environmental feature. There is also a column to document a mitigation strategy until such time that the potential hazard can be eliminated. While there is no longer any guarantee that this type of risk assessment will prevent findings from TJC it will help you to prioritize the most significant risks for immediate renovation or replacement and if your total risk score is low enough, your mitigation strategy powerful enough, and your plans to renovate on a near horizon, it may prevent RFI’s.
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