Joint Commission and Ligature Points

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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.

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Specializes in school nurse.
1 hour ago, Daisy4RN said:

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?

Yeah, the good old JC needs to keep finding "problems" to perpetuate their continued existence...

Specializes in School Nurse, past Med Surge.

Wait...I don't think I'm following this... are they concerned someone is going to strangle themselves via a rope (or a cord, bedsheet, or other fabric/material) and a chair?

Specializes in Med-Surg, Geriatrics, Wound Care.
57 minutes ago, Jedrnurse said:

Yeah, the good old JC needs to keep finding "problems" to perpetuate their continued existence...

Pretty much. There will always be a #1 cause of death by suicide in a psych unit.

Specializes in Med-Surg, Geriatrics, Wound Care.
52 minutes ago, SaltineQueen said:

Wait...I don't think I'm following this... are they concerned someone is going to strangle themselves via a rope (or a cord, bedsheet, or other fabric/material) and a chair?

Probably going to need to remove paper, to prevent suicide by paper cut.

Specializes in school nurse.
Just now, CalicoKitty said:

Probably going to need to remove paper, to prevent suicide by paper cut.

Hey now, paper cuts hurt.

To be honest, when I first saw the "you know who," they reminded me of the Asian bureaucrats in Japan, depicted by countless of Medical dramas. lol

The chief Medical professor would be making their "rounds," and then follows the horde of the loyal lemmings, all in their white coats & suits whispering their love into their ears.

Specializes in Psych (25 years), Medical (15 years).
2 hours ago, Daisy4RN said:

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?

The viewing of a situation will yield a consensual perspective of reality by rationale individuals.

In other words, Daisy, you're not missing a thing.

I've briefed through all the posts and I want to thank you all for your feedback. I thought this situation was ludachrist and you all seem to have a similar take on it.

Specializes in Travel, Home Health, Med-Surg.
1 hour ago, CalicoKitty said:

Probably going to need to remove paper, to prevent suicide by paper cut.

Yep, death by a thousand cuts, and yes Jednurse, it would hurt.

9 minutes ago, Davey Do said:

The viewing of a situation will yield a consensual perspective of reality by rationale individuals.

In other words, Daisy, you're not missing a thing.

I've briefed through all the posts and I want to thank you all for your feedback. I thought this situation was ludachrist and you all seem to have a similar take on it.

Whomever that person was that came to do the survey, seems like just added weight in TJC.

Lacks critical thinking.

Lacks common sense.

Lacks the wherewithal in what it will take for management, to consider even one additional staff member in the unit.

Specializes in Psych (25 years), Medical (15 years).
On 5/14/2019 at 9:03 AM, Daisy4RN said:

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

You know, the Walmart greeter idea came up in discussions with other rationale staff members with senses of humor, Daisy.

There's just one problem with it- Walmart greeters are probably not ready to deal with an onslaught of suicidal geriatric patients wielding nooses made out of cord, rope, bed sheet or other fabric/material desiring to attempt to commit self harm or suicide!

And that's what I told my relief: "Be prepared for that onslaught!"

Specializes in Psych (25 years), Medical (15 years).
3 hours ago, OldDude said:

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.

The OldDuderino (because I'm not into the whole brevity thing) is, truly, remarkable in his way of thinking.

To you, sir, I doff my proverbial hat.

Specializes in Psych (25 years), Medical (15 years).
2 hours ago, SaltineQueen said:

Wait...I don't think I'm following this... are they concerned someone is going to strangle themselves via a rope (or a cord, bedsheet, or other fabric/material) and a chair?

Yes!

You are following this, SaltineQueen!

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