I would like any advice or opinions on the "unlocked door" policy at the facility I work. The residents at this facility are diagnosed with mental retardation, most with profound MR. The dilemma is that we have residents that run outside and cross the street without supervision. Some will run outside in winter without proper clothing, some will run outside naked.
We have brand new remodeled kitchens that don't have doors on them. Per Medicaid, we are told, it would not be "normal" to lock a kitchen. "Is your kitchen locked at home?" we are asked. No, but I am not a danger to myself!
We have residents that run for the kitchen and grab food, wrapped or unwrapped and stuff into their mouths. We have pica behaviors, Prader Willie Syndrome, and autistic residents that play in the water of the sinks. In the bathroom that may be ok, but in the kitchen one could certainly cut their hand off in the garbage disposal or get burned on the stove. We have residents that should not have access to knives.
I am so worried about their safety once these kitchens are complete. I worry about them choking, I worry about the unlocked outer doors and that they will get hit by a car simply for the sake of "being normal". Many could say that staff should watch them more closely but that won't happen unless the facility wants to hire one on one care.
These wonderful residents have a right to active treatment, they have a right to be safe. They won't get much training if all we are doing is trying to keep them from harm. Thank you for any input.
We have similar issues where I work. One of the solutions was to use child proof locks on very specific drawers & cabinet doors. Risk management/safety committee reviews have to be done before any lock can be placed on any door/drawer to verify that the risk of injury (including choking, GI obstruction, etc along with the more obvious risks) is greater than the possible restriction to personal items in the kitchen (if free access to food is an issue in your facility--we have been able to do this with scissors & paints). Another option is to place a delayed opener on the kitchen door that would set off a message (verbal message politely announcing access to the kitchen) when a resident tries to open the door. We have been allowed to use these on our outer doors--there is a big-mac switch next to the door and a delayed lock on the door. When the switch is pressed or the handle of the door is pressed, an announcement says "I would like to go outside now," and 30 seconds later, the door opens. We have to have a teaching plan in place for every resident to teach them to hit the switch & wait for a staff in order to be able to use the delay opener. Once the teaching plans are in place, the biggest issue is to monitor & evaluate regularly. One of our buildings was cited because the effectiveness of the teaching plan didn't have enough data for one resident. The outer door that this resident used then had to have the alarm removed & we had to start over from scratch (we did end up posting an extra staff person for 6 months while we got data for his teaching plan before we were allowed to put the delayed opener back on the door). We also evaluate the necessity for each locked door/drawer quarterly & this includes reviewing all possible risks for each resident that may potentially have access. It sounds like a lot, but once it gets going, it's really just a lot of review. Oh, we also took the knobs off the stove after someone started to melt a plastic tray on one of the burners. Good luck
Last edit by LeAnne40 on Sep 11, '09
: Reason: add info