To lock or not to lock the rooms

[natalissa]

We are opening a brand new ipatient facility in Denver area (it is not open yet).

Our therapists insist we lock patients rooms during the day (their rationale is so clients participate in therapies, etc).

Could you PLEASE share if you keep your patients' rooms locked or not during the day? If you could also indicate what facility you work for that would help us greatly to determine what practice to choose.

Thank you so much.

All input will be greatly appreciated!

[iscreambiebah]

Actually as an impatient I was super paranoid because the staff would leave the doors unlocked while I was away because I was afraid people steal my things.

[Mandychelle79, ASN, RN]

Our rooms are open at all times unless the patient has a personalized behavior plan in place. The behavior plan is usually to deal with people who are malingering.

[natalissa]

THANK YOU everyone for your input!!!!!

[natalissa]

thank you for sharing!

That is what I hear, and that what makes sense. I wonder why therapists are so fixated not this idea that seems a bit counter-intuitive...

[natalissa]

Thank you so much for the feedback and sharing your experience!

All medical staff is strongly opposed to locking the rooms, but the structure of the facility is such that it is run by therapists....

The problem is there is very little data or research on the topic...

I agree that no inspector will like locking patients out to their rooms...

[natalissa]

That is understandable.

However they are talking about locking the rooms for prolonged periods of times (most of the day), not just during the times of therapy...

[vintagemother, BSN, CNA, LVN, RN]

Are your therapists psychiatrists who wrote medical orders to lock doors? If not, I don't think you should necessarily follow this practice. Maybe you can find out regs on this from your board of nursing? Even if they wrote medical orders, I think nurses still are supposed to question unethical orders.

[natalissa]

No, of course they are not psychiatrists, and they do not write orders!

But they are trying to make it the agency policy and have patients sign it upon admission....

[elkpark]

I would again encourage you to research this in your state licensing rules/regs and CMS COPs. If it's not clear from reading the rules yourself, you can contact your state licensing agency directly and ask for clarification. Best wishes!

[Stephalump]

We lock doors - depending on the unit, doors are locked for all patients during group classes or only for patients who have been refusing to go to class recently.

I hate the policy. Patients refuse to get up for med pass and sometimes meals for fear that their doors will be locked. Floridly psychotic patients spend the hours of group time harassing staff and other patients because they aren't in any shape to sit through classes but they can't be alone.

In some cases, I think it's beneficial for a patient to be made uncomfortable enough that they choose group. But having a blanket rule takes away my ability to prioritize a pt's needs. My stable pt with full blown AIDS needs medications and food more than he needs to sit in the milieu for hours, because he ain't going to class.

[Stephalump]

Also, I should add that here it violates a patient's rights to keep doors locked ALL day. But it's a slippery slope. If group starts at 9:30 but breakfast is at 7am, locking the doors at 9:20 won't work for patients who refuse to get out of their rooms when asked. So when do you lock them? In our case, they're being locked out during breakfast, and I've had to intercede to keep them from being locked throughout lunch as well.

[hiphopRN]

For us we can only lock doors if it was part of their treatment plan. The most common instances we use this for are med paneled patients that have been seen cheeking or spitting out medications. We lock their doors after they receive medications for ~30min or however long is dictated in the treatment plan. Very rarely do we lock for not participating, and that is only after they've been with us a few weeks and that is still only after we write it into the treatment plan.