Unlocked Doors at MRDD facility

[Bulwark]

I would like any advice or opinions on the "unlocked door" policy at the facility I work. The residents at this facility are diagnosed with mental retardation, most with profound MR. The dilemma is that we have residents that run outside and cross the street without supervision. Some will run outside in winter without proper clothing, some will run outside naked.

We have brand new remodeled kitchens that don't have doors on them. Per Medicaid, we are told, it would not be "normal" to lock a kitchen. "Is your kitchen locked at home?" we are asked. No, but I am not a danger to myself!

We have residents that run for the kitchen and grab food, wrapped or unwrapped and stuff into their mouths. We have pica behaviors, Prader Willie Syndrome, and autistic residents that play in the water of the sinks. In the bathroom that may be ok, but in the kitchen one could certainly cut their hand off in the garbage disposal or get burned on the stove. We have residents that should not have access to knives.

I am so worried about their safety once these kitchens are complete. I worry about them choking, I worry about the unlocked outer doors and that they will get hit by a car simply for the sake of "being normal". Many could say that staff should watch them more closely but that won't happen unless the facility wants to hire one on one care.

These wonderful residents have a right to active treatment, they have a right to be safe. They won't get much training if all we are doing is trying to keep them from harm. Thank you for any input.

[nurseinmo]

I feel you pain! I worked at what sounds like a very similer facility until recently and we went through this very same struggle with the management. The way our facility was set up we had one building on each side of a main highway that runs through town and had more than one occurance where lower functioning individuals left their areas and crossed this road unsupervised. Thank God nothing ever happened to one of them (yet) but after what I felt were some very poor decisons on the part of the managers and another incident were we "lost" a deaf autistic man for about 10 minutes and found him alone outside...I finally decided that it was in my best interest to leave the facility. I loved my job and the individuals that I cared for, but the people making the important decisions about their care at this particular facility do not have medical training and there was too much happening that I felt was jeopardizing my licence for me to be able to stay.

As far as where you are now, you can only do the best you can do. Teach you staff and stress how extremely important it is that they know where their individuals are at all times. Maybe as for the garbage disposals they could cover the switches somehow? In one of our buildings all of our light switches were only able to be turned on or off with a key and we got away with that so it's a thought at least. Our facility kept a seperate kitchen and the individuals only had a "cooking class" every so often so no knives or food were kept on the areas where they lived and I can see how this would be a concern....I don't really know what other advice to give but keep us posted on how it goes.

[Aussie19]

We used to have alarms on exit doors but Medicaid sited that as a privacy rights violation and we had to take them down. Now the policy is that there must be a staff in the living/dining room area at all times monitoring the exit doors and entrance to the kitchen. You cannot lock the kitchen door but you can redirect the residents to another area for active treatment. That is how it has been handled where I work. It is not 100% but have not come up with a better solution yet.

[morte, LPN, LVN]

i am roflma.......if you were a parent, and didnt secure the kitchen and the exit doors....how long do you think it would take for someone to call child protective services?????

[LeAnne40]

We have similar issues where I work. One of the solutions was to use child proof locks on very specific drawers & cabinet doors. Risk management/safety committee reviews have to be done before any lock can be placed on any door/drawer to verify that the risk of injury (including choking, GI obstruction, etc along with the more obvious risks) is greater than the possible restriction to personal items in the kitchen (if free access to food is an issue in your facility--we have been able to do this with scissors & paints). Another option is to place a delayed opener on the kitchen door that would set off a message (verbal message politely announcing access to the kitchen) when a resident tries to open the door. We have been allowed to use these on our outer doors--there is a big-mac switch next to the door and a delayed lock on the door. When the switch is pressed or the handle of the door is pressed, an announcement says "I would like to go outside now," and 30 seconds later, the door opens. We have to have a teaching plan in place for every resident to teach them to hit the switch & wait for a staff in order to be able to use the delay opener. Once the teaching plans are in place, the biggest issue is to monitor & evaluate regularly. One of our buildings was cited because the effectiveness of the teaching plan didn't have enough data for one resident. The outer door that this resident used then had to have the alarm removed & we had to start over from scratch (we did end up posting an extra staff person for 6 months while we got data for his teaching plan before we were allowed to put the delayed opener back on the door). We also evaluate the necessity for each locked door/drawer quarterly & this includes reviewing all possible risks for each resident that may potentially have access. It sounds like a lot, but once it gets going, it's really just a lot of review. Oh, we also took the knobs off the stove after someone started to melt a plastic tray on one of the burners. Good luck

[msu2011]

At my MRDD facility, we are required to have a medication cabinet with a pad lock. So having medications in an unlocked cabent does not make a lick of sense.