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.

[Davey Do]

6 hours ago, kbrn2002 said:

this is beyond bonkers. So if I get this right the floor can be short staffed already, probably per usual but somebody still has to do nothing but be a door?

And, kbrn, it's not the whole story- it's merely the gist.

For example, the staff acting as the door, doing absolutely nothing, could have easily performed the duty of watching a patient who was on a Line Of Sight (LOS) status during the day only because they had a urinary catheter.

However, someone deemed that if a patient is a LOS during the day, they must be on a 1:1 status at night.

So, in essence, there were three staff members in a relatively small area being responsible for two patients.

There was also a staff member working the floor, making rounds and a charge nurse at the desk.

A total of five staff members for 12 patients.

[TriciaJ, RN]

Here's a scathingly brilliant idea: why not just change out the chairs to ones with no ligature points? Upholstered in vinyl without legs. Wouldn't that solve the problem without structural changes and extra staffing?

[Davey Do]

39 minutes ago, TriciaJ said:

Here's a scathingly brilliant idea: why not just change out the chairs to ones with no ligature points?

Ironically, TriciaJ, the adult men's and women's units have ligature free chairs- they also have community rooms with locking doors!

[nursosarus, CNA, RN, EMT-I]

As I have said many, many times, WHERE DO THEY GET THEIR REASONING?? Why don't these pencil pushing bureaucrats ever talk to people who actually do the work, see the actual, not perceived, problems, and have to deal with many irrational regulations. Maybe they don't think we are smart enough to think on their level.

[Davey Do]

1 hour ago, nursosarus said:

Why don't these pencil pushing bureaucrats ever talk to people who actually do the work

My sentiment exactly, hursosurus.

[panurse9999]

My greatest hope is that oversight bodies, such as Joint Commission, and others, will be required to fund, the unfunded mandates that they demand from institutional care. The funding will come from the government, who then will be forced into looking at the cost of their regulations, which should lead to fewer of them.

[Davey Do]

As I was sitting being a Door, I came up with an idea about a song for that musical called "Joint Commission Superstar".

Maybe I could do a little dance number to the tune of "Camp Town Races"?

[Davey Do]

Quote

I jumped for joy like some jerk excited over new phone books as I came onto the geriatric psych unit on Friday for my MN shift. Everything was going to be okay now- no more sitting for two hours being a door.

However, new problems have arisen.

Only one of the double doors open, which means some things cannot pass through the single door, like wheelchairs, meal carts, or crash carts.

The doors are to stay locked 24/7, so the staff member assigned to the community room during the patients' waking hours, are locked in there with them. The staff member assigned to work the floor and make rounds use to be able to sit in the community room and walk the hall. Now, an extra staff member is required to just walk the hall in order to make rounds.

The video monitors are down, so staff at the nurses station have no idea of what's going on in the community room. And, like deep space, with the doors closed, "no one can hear you scream".

Scary!

[Daisy4RN]

Well that was a short lived euphoria wasnt it?!

Yep, sounds like a typical JC solution to me. I think I would rather continue to be a door than locked in a room with anyone.

Be safe out there!!

[CalicoKitty, BSN, MSN, RN]

Why would the door need to be locked if a staff member was in the room?? And how is that safe, or even legal? In many cases, you can't lock a patient room (seclusion aside) because of safety. How is locking a room with patients now not a safety issue?

[Davey Do]

9 hours ago, CalicoKitty said:

Why would the door need to be locked if a staff member was in the room?? And how is that safe, or even legal? In many cases, you can't lock a patient room (seclusion aside) because of safety. How is locking a room with patients now not a safety issue?

Good questions, CK!

Patients may leave the community room at will, as the door does not lock from within, but a staff member must unlock the door from the outside, or open it from the inside, to let the patient(s) in.

So, actually, the patients are not locked in, they are locked out of the community room.

It also has been noted that neither doors on the men's and the women's psych units have the community room door locked during the day- only from 2200 to 0600.

So, seeings how this 24/7 locked door thing does not jive with the other psych units, this shift, due to a lack of staffing to cover both the hall and the community room, the door was propped open with a chair.

We'll see how administration responds to this when and if they review the video monitors that may or may work outside of the geriatric psych unit.

I'll keep you posted!

Stay tuned.

Fine tuned.