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.
Specializes in Psych (25 years), Medical (15 years).
3 hours ago, TriciaJ said:
That's a good idea. One of the commentators should have a segment called "Medical Stupidity (or Your premiums at work)".
Or, TriciaJ, "Hospital Administration Stupidity".
Two decent RNs who were staff nurses were promoted to the position of house supervisor. I swear- both are now making decisions as stupid as the rest of administration.
This is either an example of the Peter Principle (rising to the level of one's incompetence) in play, or they had to have part of their brains removed in order to become administrators!
Specializes in Psych (25 years), Medical (15 years).
3 hours ago, CalicoKitty said:
Does Psych have to give bedside report? I can imagine how well that would go!
No, Calico, psych does not have bedside report. Just the opposite.
A short time ago, the geriatric psych nurses station was open; merely a counter separated the nurses station from the hall. It has since been glassed in.
When it was open, patients were instructed to leave the area of the nurses station during shift report, for reasons of confidentiality.
Even if the patient had dementia to the point they were oriented only to self, they had to leave the area for fear of breaching HIPAA.
Specializes in Psych (25 years), Medical (15 years).
3 hours ago, TriciaJ said:
This actually reminds me of a patient years ago who voiced a plan to commit suicide by giving himself cigarette burns. We thought that might take a few packs, or maybe even a whole carton.
Ouch, TriciaJ.
We had a patient referred to the geriatric psych unit by a therapist because he wrapped toilet paper around his neck and planned to hang himself.
They do make Ultra Strong Charmin toilet paper, you know.
I did a comic of the Suicide by Charmin but was unable to locate it in my files. But, in the meantime, I found another COW comic:
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
1 hour ago, Davey Do said:
Or, TriciaJ, "Hospital Administration Stupidity".
Two decent RNs who were staff nurses were promoted to the position of house supervisor. I swear- both are now making decisions as stupid as the rest of administration.
This is either an example of the Peter Principle (rising to the level of one's incompetence) in play, or they had to have part of their brains removed in order to become administrators!
Specializes in Psychiatry, Community, Nurse Manager, hospice.
I want to be a door. You want ice? No can do, I am a door today. You need more Ativan than is prescribed? Well, I am just a door. And one that can't even open at that.
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?
They determined our acoustic tiles were ligature risks because they're "too easy" to push up into the dropped ceiling. So we had to replace them with tiles that are "clipped" in (still just as easy to push up) and bounce sound creating echoes all across the unit. The noise level is unbearable now. Plus the doorknobs had to be changed suddenly after years of being just fine, furniture, and we can't have trash bags in our nursing station now. It's awesome. We have to use paper bags in all the trashcans, which leak constantly. Yay for infection control.
Specializes in Psych, Addictions, SOL (Student of Life).
After our last JC survey our facility changed all the door knobs, sink, toilet and shower fixture to have no ligature points. It took a couple of weeks just to figure out how to open doors, turn water off and on - new fixtures did not come with any instruction. Plus water in sinks and showers is push button and only stays on for 1 minute at a push.
You have just successfully described JCAHO (thats right JCAHO, not Joint Commission) to a tee!!
An Independent org that has too much power and little (if any oversight). Hospitals pay this org in order to get their little gold star.
A few other regs I always liked are:
The patients pain is what ever the patient says it is, and don't worry patients wont get addicted to pain meds if they are in pain.
No, you cannot carry saline flushes in your scrub pocket because it is unsafe. So back to the end of the Pyxis line for you.
White Boards. Patients cannot remember your name so we need you (as top priority) to put your name on the board (so they know exactly who to blame for everything). Some how the board evolved into also including, date, diagnosis, DC date, CNA name, nurse phone no. etc etc. and my all time favorite the patients stated goals for the day.
Here is a real convo with a pt (except the last line):
Nurse: What is your goal for today?
Pt: I want to win the lotto (pt was serious)
Nurse: (Sigh!!) Well, we are actually looking for a health care related goal that is on your care plan (don't even get me started on care plans!)
Pt: If I win the lotto I don't have to care about your *%&*# care plan and can leave.
Nurse: Ok then, I hope you win the lotto too so I can stop running in here every 5 min for your *%&*# requests.
Specializes in Community Health, Med/Surg, ICU Stepdown.
thanks to the JC we can no longer adjust the thermostat in patient's room as it is covered by a glass protector so that patients can't touch it... not sure if the temperature knob was a ligature risk or if there is a risk dementia patients will crank the temp to 90 all day but now we get to call the engineer's office every time a patient wants the room temp changed from 71 to 71.5. The engineers are usually busy fixing things and they listen to the voicemail 2 hours later when the patient is irate that the nurse hasn't taken care of the request. When the temp is finally changed the patient usually wants the temperature cooler and the whole process starts over again. ?♀️then HCAHPS asks the patients if there preferences were taken into account and they say "those f***ing nurses froze me all day!"
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Davey Do
10,666 Posts
That's correct, Daisy; no charting by the staff member acting as a door.