To lock or not to lock the rooms

elkpark · Oct 17, 2014

I suggest you check the state mental health and patient rights rules (that apply to your facility); they may address this.

natalissa · Oct 17, 2014

Thank you Elkpart,

the only thing Colorado patient rights rule says to that effect is "patients have a right to the least restrictive treatment"

Apparently it is a very common practice to lock patients rooms during the day across the country.

I am just trying to get as much feedback as possible to see if it is really a common (and helpful) practice.

I realize it would not be official data, but it would help to know what other facilities practices are.

Thank you

amoLucia · Oct 17, 2014

To OP - is that a real first name? It is beautiful!!! I've never said that to someone on a post before.

I don't do psych, but could 'least restrictive environment' be extended to imply that you've restricted a pt's environment by locking him/her out of the room? Could a lawyer expand on that if representing a very PO'd (and high functioning & knowledgable) pt?

I think your legal dept people should be checking out this issue since it's in question. Just because others do it, doesn't mean it's right.

JMHO

suzetteq · Oct 18, 2014

At our facility we rarely locked patients out of their room, but it was occasionally necessary at the request of the Dr, the treatment team or even the patient. We would only do it with a doctors order for therapeutic reasons.

MrChicagoRN, RN · Oct 18, 2014

At our facility we rarely locked patients out of their room, but it was occasionally necessary at the request of the Dr, the treatment team or even the patient. We would only do it with a doctors order for therapeutic reasons.

Ditto

only in very rare and specific cases does that happen with us. As in, I could count on the fingers of one hand how often this has occurred at any facility.

It is probably illegal and could threaten your accreditation.

It it is not patient centered care as everyone is required to attend groups, and can't opt out, or refuse treatment. What about patient autonomy, individualized care planning and the requirement that the patient be a participant in their care planning?

Sometimes a person is profoundly depressed, unable to participate in a morning group. May be too anxious to participate, may be responding to A/V H, or too paranoid. Medications may not be doing enough or may be too sedating.

Possibly a human rights violation. Better get a legal opinion before you allow therapists to prescribe treatment and you initiate a one size fits all treatment plan.

Whispera, MSN, RN · Oct 18, 2014

Patients have the right to refuse to attend groups. We encourage strongly but locking their rooms is somewhat equivalent to forcing them to do what they don't want to do or are incapable of doing.

I have a big problem with a locked-room policy.

2011RN · Oct 18, 2014

I have worked at places that lock the doors and places that do not. Over all I think that the place that handled the situation the best was the one that left the doors unlocked all the time. If a patient was not attending groups with encouragement then the physicians would put in an order for that particular patients door to be locked but only during group times. Ultimately it was still up to the patient whether they attended the groups or not. If they still did not want to attend they could go to another area on the unit. Some patients would end up going to groups some continued to refuse...

Meriwhen, ASN, BSN, MSN, RN · Oct 18, 2014

I've worked at facilities on both sides of the country, from for-profit to state-run and everything in-between. The ONLY times I've ever seen a patient locked out of their rooms is if repairs were being made in there, or if the room was not inhabitable for some reason. They were assigned an alternate room during those times so they always had access to a bathroom and a place to lie down.

I disagree with your therapists. Psych patients have the right to refuse to participate in treatment. Some may be forced by court order to take meds, but they are in no way forced to attend groups. What your therapist propose IMO is likely in violation of patient rights and also your state's law.

And I'll be honest with you: if Joint or Medicare or another accrediting agency came by and saw this and you tried to use the "but other facilities do this, it's common practice!" argument, I can guarantee that it will **** them off more than it would help your facility's case. When the inspector is standing in YOUR facility, it doesn't matter to them in the least what facilities across the country do: they're only interested in what YOUR facility is doing.

Tread very carefully.

amoLucia · Oct 19, 2014

This reminds of an old trick CNAs used to use --- they would put the pts' beds up flat in the highest position possible. It was their attempt to force the pts to remain active on the unit and to keep them out of their neatly made-up beds. Pts would fall trying to get back up into the high beds or they'd be lying on the floors.

This used to occur some long time ago (long before Pt Rights were so emphasized) and surveyors negatively observed the trick.

lasair · Oct 19, 2014

I think it should be assessed on an individual bases and be in the best interest of the patient. Maybe have it as part of their care plan, like if x doesn't participate in their care plan then their mental health will degenerate. The individual would need to be held under the mental health act/ involuntary for this to be considered....unless the individual agrees to it or requests for their room to be locked for a set period of time.

vintagemother, BSN, CNA, LVN, RN · Oct 20, 2014

We don't lock doors at either of the in pt units I work in. We will counsel the pt that participating in groups relevant to their needs is a reqmt in some cases to be discharged.