Safety and Unsupervised bathrooms

[CLSHPIRN]

I apologize if there is another thread about this subject, but I've only been able to find one other post. I work in a small (120 bed) state-run psychiatric hospital. We provide intermediate care to primarily involuntarily/judicially committed patients with an average LOS of ~60-180 days. Our patient units and therapy areas are secure (locked).

This is the question: How do similair facilities deal with patient safety in bathrooms? On the patient living units, our bathrooms are typically left unlocked but monitored by Nursing staff. During the day, most of our patients leave the living units and spend the day at another building called the therapy mall. On one side of this mall, groups are provided by Nursing staff, and the bathroom is left unlocked but patient use is monitored by Nursing staff. On the other side of the mall, groups are provided by Activity Therapists. On this side however, the bathrooms are left open, but there is no staff to monitor patient flow.

Do similar facilities typically leave bathrooms unlocked? If so, how do you mitigate the associated risk - especially in light of NPSG 15.01.01?

Thanks in advance for any comments!

[bymysoul2squeeze]

I work in an acute psych unit with both commited and voluntary patients. the bathrooms stay open all day (staff is doing q15min checks on patients so if they are in the bathroom they still check on them) the showers are only open between 6 and 8 am/pm and then locked

[MrChicagoRN, RN]

So, are those bathrooms checked at all? Every 15 minutes? Never?

What is the condition of all the bathrooms. Have all ligature risks been eliminated?

[cjcsoon2bnp, MSN, RN, NP]

At my facility our patient bathrooms are locked and if patients need to use them then they ask the staff to unlock them. Too much risk for self harm and harm of others if we don't keep them locked. I work at a Pediatric Psych. Hospital by the way.

!Chris

[CLSHPIRN]

So, are those bathrooms checked at all? Every 15 minutes? Never?

What is the condition of all the bathrooms. Have all ligature risks been eliminated?

This area is staffed only by therapists. Patients are accounted for every 15 minutes (at the beginning of group, mid-group, and before group dismisses) and the bathrooms are informally monitored - but no official q 15 minute checks.

Unfortunately the ligature points have not been eliminated. The patients on the treatment mall are usually higher level and we have had no incidents of attempted self harm in these bathrooms. Despite this, the potential for self harm remains a huge concern - as well as concerns about patient to patient sexual activity/rape/etc.

[MrChicagoRN, RN]

If potentially suicidal patients ever have access to these unmonitored bathrooms, there is a risk.

Consider at the very minimum, that there be formal bathroom checks q15. However, someone could hang themselves from the faucets, or the plumbing underneath in less time than that. Has your managers, and risk manager done an environmental risk analysis?

FYI, routinely locking patient bathrooms could be a violation if every patient has to ask for staff to let them use the bathroom each time.

[elkpark]

I've worked in child and adult psych (inpatient) over many years, and I've never worked anywhere that kept the bathrooms locked routinely. In my experience, clients are supervised closely, not rooms. If someone is on a higher level of supervision for safety reasons, the door to the bathroom in the room is locked and the individual has to be observed while in the bathroom -- but that has only applied to people considered to be at higher risk than the general population of the unit.

Also, in my experience, clients who are considered a higher safety risk than the general population, and to need a higher level of supervision, are not considered appropriate for activities and programming off the unit.

[Meriwhen, ASN, BSN, MSN, RN]

I've also never worked at a place where bathrooms were routinely locked. They may have locks on the doors, but they were never kept locked unless that bathroom couldn't be used for some reason. One facility had bathrooms in the patient rooms, but they had sliding doors that couldn't be locked.

All patients get visually checked a minimum of q15 minutes, including if they are in the bathroom or shower.

If you are concerned about the safety of a particular patient in the bathroom, then the solution is not locking the bathrooms up, but increasing the monitoring of the high-risk patient.