Joint Commission and Ligature Points

[Davey Do]

Last week, Wrongway Regional Medical Center (WRMC) had a Joint Commission survey. The surveyors found ligature points, being chairs, in the community room. A ligature point is defined as "A feature in an environment which could be used to support a noose or other strangulation device (especially, for the purpose of attempting to commit suicide)".

Joint Commission has ruled that patient care areas are to be “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.”

The area of concern Joint Commission found was that the geriatric and child psych units community rooms were without doors. Therefore, it is believed that patients could unnoticeably enter the community room with noose made from a cord, rope, bed sheet or other fabric/material and attempt to commit self harm or suicide. Therefore, doors with locking devices need to be installed on the community rooms.

Fine. Sure. Okay. I guess, theoretically speaking, a suicidal patient could enter the community room unnoticed with a noose made out of a cord, rope, or bed sheet or other fabric/material, stand on a chair, throw it up over some ligature point and attempt to commit self harm or suicide. So doors need to be installed.

But what to do in the meantime?

WRMC administration has deemed that, until doors with locking devices can be installed, a specific staff member will act as a door, sitting in front of the community room doorway 24/7. This staff member will assure no suicidal patient will enter the community room with a noose made out of a cord, rope, bed sheet, or other fabric/material and attempt to commit self harm or suicide!

That staff member acting as a door will be allowed to do nothing else: No patient care, no 15 minute safety rounds, no charting, and of course no electronic devices of any sort, or reading material of any kind! The staff member is to just sit there and act like a door!

I kid you not!

The staff member assigned as a door will be relieved every 2 hours.

[KonichiwaRN]

Sounds genius. I mean. It's awesome. Brilliant. I'd open a guinness if I actually liked to drink that.

How about this?

"Let's remove the chairs in the common room and place cushions there instead."

?

[Davey Do]

There are several circumstances where I have found my art to be prophetic. One such case occurred here on allnurses with the cartoon caption contest.

I heard about the Joint Commission ligature thing when I went into work on Friday, May 10, 2019.

This is my submission to the cartoon caption contest dated Friday, April 26, 2019:

[Davey Do]

4 minutes ago, KonichiwaRN said:

"Let's remove the chairs in the common room and place cushions there instead."

?

Migod man, you're a genius!

WRMC staff have come up with several alternative interventions, like: At night, move the chairs to the conference room which has a locking door.

I don't understand the 24/7 thing either. The doors will be unlocked during the day, so why is a staff member acting as a door stationed there during the day?

Perhaps the staff member acting as a door during the day is actually a staff member acting as an unlocked door?

[TriciaJ, RN]

Do management and JCAHO have contests with each other to see who can come up with the stupidest thing? Just how many successful suicides have occurred in open dayrooms with chairs?

[Davey Do]

2 minutes ago, TriciaJ said:

Do management and JCAHO have contests with each other to see who can come up with the stupidest thing? Just how many successful suicides have occurred in open dayrooms with chairs?

Doncha just love it when a perspective is consensual with others whose logic is based in reality?

I know of no successful suicides that ever occurred in a community room at WRMC, TriciaJ. Two successful suicides that come to mind occurred several years ago at WRMC took place in a shower and patient room.

Neither one used a chair.

I also wonder: How does one solely use a chair as the ligature point?

[KonichiwaRN]

Sounds too complicated.

Too much risk factors. What if a staff member "pulls a muscle" moving those chairs?

Also, it is very demeaning to force a person to "act like a door." What about the trauma that could be involved? This could potentially end up in a civil rights battle. They're not even going to let the person the right to read a book never mind the person's cell phone?

It also doesn't consider the population with a overactive bladder syndrome. No bathroom breaks?

What kind of training would the person have to have? No doubt since it's a Psychiatric floor, the person would need self defense lessons as well. Just to act like a door.

Sounds too complicated. I think we should write TJC a letter. It is very demeaning for the innocent being to be in that place in such a manner.

And health care costs are rising even more.

[TriciaJ, RN]

19 minutes ago, Davey Do said:

Doncha just love it when a perspective is consensual with others whose logic is based in reality?

I know of no successful suicides that ever occurred in a community room at WRMC, TriciaJ. Two successful suicides that come to mind occurred several years ago at WRMC took place in a shower and patient room.

Neither one used a chair.

I also wonder: How does one solely use a chair as the ligature point?

Collapsible chairs, maybe? What are they doing about the shower heads? They're going to have to appoint another staff member as shower monitor. Until that poor person gets accused of something. Then they'll have to put in carwash-type showers. Until someone gets caught in the buffer. I could have fun with this all day.

[Daisy4RN]

Aw JC, always coming in with those great ideas, what would we do without them!

I am a little confused how that would work. Does the door have an alarm so you all know when someone enters. It would seem more safe to have no door so the patients are visible. What am I missing?

[Daisy4RN]

I always though I would work as a Walmart greeter for a retirement job. Maybe a job as a door would be better, hmm..

[OldDude]

I think the approach is all wrong. Patients should be provided with "safe" cord, rope, bedsheets, or other fabric/material that would not facilitate death or serious bodily injury in the event of suicide or other attempt. All hospital material should not be capable of sustaining a weight of more than 5 pounds or sustain a constant pull of more than 5 pounds for more than 60 seconds. This way all ligature points could remain in place and functional for ADLs and there would be no need for locked doors or personnel assigned to impersonate a locked door.

[Daisy4RN]

1 minute ago, OldDude said:

I think the approach is all wrong. Patients should be provided with "safe" cord, rope, bedsheets, or other fabric/material that would not facilitate death or serious bodily injury in the event of suicide or other attempt. All hospital material should not be capable of sustaining a weight of more than 5 pounds or sustain a constant pull of more than 5 pounds for more than 60 seconds. This way all ligature points could remain in place and functional for ADLs and there would be no need for locked doors or personnel assigned to impersonate a locked door.

Yes exactly, sheets etc made out of material like those one time use scrubs!