To lock or not to lock the rooms

[natalissa]

We are opening a brand new ipatient facility in Denver area (it is not open yet).

Our therapists insist we lock patients rooms during the day (their rationale is so clients participate in therapies, etc).

Could you PLEASE share if you keep your patients' rooms locked or not during the day? If you could also indicate what facility you work for that would help us greatly to determine what practice to choose.

Thank you so much.

All input will be greatly appreciated!

[cjcsoon2bnp, MSN, RN, NP]

I would be extremely hesitant to have a policy that has the doors to patient's bedrooms be locked in order to force them to attend groups. I have seen physician orders at my facility (a pediatric psych. unit) that prevents the patient from using the bathroom for one hour after meals for patients who are known to purge but it requires a treatment team meeting and is seldom utilized.

To put this in context, our bathrooms are always locked and a staff member has to open them when patient needs to use them. If a patient has the "No bathroom 1 hour after meals" order and needs to use the bathroom then a staff member is expected to stand at the door to monitor if the patient is attempting to purge.

I agree with other users that you should be checking with the DOH and BON to see there take on this policy but I think there are other less-restrictive ways to encourage patients to participate in group without locking them out of their rooms.

!Chris

[natalissa]

Thank you again, Elkpark:)

I am sorry if it sounded as if we were not going to check our state rules and regulations, and go off what other facilities are doing by gathering information on allnurses

It is certainly not the case.

But it helps a lot to have an idea what practices are in place elsewhere.

THANK YOU

[natalissa]

Thank you so much for all the responses!!!:)

[VivaLasViejas, ASN, RN]

I just got home after a week's stay in a psychiatric facility, and must say that I would've been extremely upset if I couldn't have access to my room. The first day I got there, I was too depressed to want to socialize, and I appreciated being allowed to come and go as I pleased. The next day I felt a little less shaky and came out of the room, and most of the rest of the time I stayed out in the common areas and went to every group therapy session except for the arts and crafts. It also made the nurses' job a bit easier since they knew where to find me (I was on suicide watch for the entire stay).

The staff did lock the bathroom of one patient who tried hacking at his wrists with the bristle end of his toothbrush and stood outside while he did his thing. That's understandable. But locking people out of their rooms to make them go to groups is not fair, although it must be said that at minimum, it looks good for the patient to attend sessions because it means you're working toward your goals (and gets you out of there sooner).

Personally, I took advantage of group therapies and benefited greatly from them. Some of the other patients, not so much. I'm just glad nobody locked me out of my room to encourage me to do something I would have done anyway.

[RainMom]

If it were me, locking my door to coerce me to do something would probably have the opposite effect. When told I CAN'T do this or that I WILL do that, it just brings out my stubborn streak! At least give them a chance to find their way & come to the realization that groups are for their benefit, not just an activity forced on them.

Viva, hope you are feeling better. Take care of yourself!

[jdewberry]

We do lock the doors at our facilities but for patient safety reasons. We do not have enough staff to monitor halls at all times. However, if a patient wants to go to their room, we immediately unlock it and staff the hall. We would never keep them locked out to make them go to class. That is a restriction and a violation of their rights. It would take a doctors order to do that here and I have yet to see it done. I also work for a state facility in Texas.

[PeacockMaiden]

I work on an inpatient psych unit for adolescents. We do lock the doors for patient safety. Adolescents can be sexually acting out persons, and if the doors are unlocked, some patients will try to sneak off and have sex. So I agree with locking the doors for the adolescents.

In the adult units, the doors to the rooms are not locked. We encourage to come out and participate in groups, but we don't force them.

[TerpGal02, ASN]

At the facility I just left (not sure my new units policy) the only way you could lock a patient out of their room was with a doctor's order and that was only if the patient was failing to stabilize because of their isolation or was decompensating further because of it. And this is with adults. We would usually lock them out from 0800 to 1500 when groups are pretty much back to back. We would also lock any pts bathroom for 30 minutes after meals if theyhad a history of an active eating disorder. The children and adolescents were never locked out but if they were refusing groups they would lose privledges so.......

[gzussu]

I work at a facility where we keep rooms locked all day. I'm torn. On the one hand, I think that the elderly psych patients should be allowed in their rooms to rest more often. I also think that we should allow the extremely disorganized/bizarre schizophrenics who are at their baseline with no possibility for improvement into their rooms more often. The ones we have are soooooooo far gone but they are no threat to themselves, though one can be a threat to others if he doesn't get his way. These guys will be institutionalized for the rest of their lives.

As for the others, I agree with keeping the doors locked. Otherwise, they will lay in bed all day, they won't get up to participate in groups, they can be a risk to themselves, etc...

But our facility is so jacked up. We have substance abusing malingering aholes who are seeking 3 hots and a cot until their next payment of free money mixed in with true psych patients.

Patient's don't have to participate in all the groups...if they don't, they can sit and watch tv or use the phone or play cards/games with others, etc. Laying in bed all day long isn't going to help them get any better. Plus, if they are homeless and using our system just for a place to stay, I sure as hell don't want to make their stay comfy. Laying in bed all day isn't healthy. And that is what our patients will do if we allow it.