In addition to the potential safety hazards of using standard furniture in patient bedrooms, fixtures and other elements such as window coverings and hardware also warrant careful consideration to minimize injury and despoiling in behavioral health settings.
Windows, doors, flooring, hardware and fixtures in patient bedrooms and bathrooms need to be extremely durable as well as tamper-resistant. After the primary concern for patient safety, facility designers and managers need to consider product performance and suitability that will hold up to years of intensive (and perhaps unpredictable) use, as well as frequent cleaning and disinfecting with harsh detergents.
Architect and consultant James Hunt, AIA, NCARB, says there is “no one size fits all solution,” but he offers several options that could work in a number of applications, as well as for a range of budgets. He shared the following guidance in an article published in Behavioral Healthcare magazine in 2010.
Safety Measures Breakdown
Below is a breakdown of safety measures you should consider in furnishing patient rooms.
Windows and window coverings
Windows are highly susceptible to abuse by patients, according to Hunt. Because of this, adequate selection of durable glass is essential for the patient bedroom. The FGI Guidelines refers facilities to specific American Society for Testing and Materials (ASTM) tests for window glazing impact resistance ratings.
Some psychiatric facilities choose to use clear polycarbonate (Lexan) for windows in patient areas because it is very difficult to break. However, it is susceptible to being scratched. There are some mar-resistant and abrasion-resistant coatings available that will help reduce this problem. In the event that patients scratch the polycarbonate windows, Hunt suggests keeping replacement panels on hand.
Window coverings pose a potentially high safety risk for patients, as blinds, draperies, curtain rods, and cords or chains for adjustment could be used for hanging. To prevent this, Hunt identifies “mini-blinds sealed between layers of the exterior window glazing” as the best selection for window coverings, provided that “the device used to adjust the position of the blind [does] not provide a ligature attachment point.”
For facilities that cannot afford or use such window coverings, Hunt makes another suggestion: a flush-mounted track with break-away drapes. This track is directly mounted to the ceiling, reducing the risk that patients can hang from it. The fabric selected for the drapes should be “breathable, to reduce the risk that patients use it to suffocate themselves.” Facilities should also be sure to eliminate any and all cords, chains, and wands typically used to adjust drapes.
Hunt asserts that the selection of doors and door hardware for patient bedrooms remains “a complex issue without a clear solution at this time.” However, he does have several recommendations that he has found to be effective in his own behavioral health facility design projects.
His first recommendation is to select an “in-swinging” door for the bedroom. However, he notes that this could pose a potential opportunity for patients to barricade themselves in their rooms. To reduce this risk, Hunt presents several options:
- A “door within a door,” or “wicket.” Hunt says that this “smaller panel in the center of the primary door” should be hinged to swing outward into the hallway, but should be locked at all times, except in emergencies.
- An unequal pair of double egress doors. “This involves a primary door of the required width that swings into the room and an adjacent door that is approximately 18 inches wide that swings into the corridor,” Hunt says. “The narrow leaf should be locked at all times, except in emergencies.”
- Similarly, facilities could also choose an unequal pair of doors divided by a mullion-or vertical frame-that separates two doors. “[This] provides a more secure attachment of the smaller leaf,” Hunt says.
- A double-acting door with an emergency stop. “This door normally swings into the room and can be swung out if a device in the jamb is depressed to allow movement in the outward direction,” Hunt says. “This solution requires the use of center pivot hinges which present some potential hazards.”
- Anchored furniture, which reduces the possibility of the barricade hazard.
Hinges on all door selections should be continuous (piano hinges) with sloped “hospital tips,” according to Hunt. All applicable code and regulatory officials must be consulted before deciding on any of these suggestions.
Door locks may also present an opportunity for patient suicide or self-harm, as they provide attachment points from which one could hang a ligature. Because of this, Hunt says that “standard knob or lever locksets should never be used on any patient accessible door.” Instead, he suggests the following options:
- Anti-ligature levers with a conical rose (the knob rose is a round plate or washer that forms a knob socket and is adapted for attachment to the surface of a door)
- Push/pull locksets, also known as paddle handles, that resist downward pressure; and
- Crescent handle locksets, which resist upward, downward, and transverse attachment.
An over-the-door alarm can alert staff if a hanging attempt is being made by a patient. These pressure-sensitive strips are available from at least three companies, Hunt says.
Floors of patient bedrooms pose less of a safety risk than other components. However, patients may be inclined to damage or urinate on floors, according to Hunt.
To secure flooring and prevent it from being picked or pulled loose, Hunt suggests sheet vinyl or broadloom carpet. “Both of these materials provide a minimum of seams at which patients can tamper,” he says. Solution-dyed yarn and moisture-resistant backing for carpet is also preferred.
If urination is a high concern, Hunt suggests seamless, resinous flooring which is durable, resistant to chemicals, and easy to clean with an integral base.
According to the Joint Commission, 75 percent of suicides in behavioral health facilities occur by hanging in a patient bedroom or bathroom. Because of this, facilities should take as many precautions as they find necessary to protect their patients from self-harm or suicide in these environments.
“Each facility must evaluate its patient population, staffing, and other issues to determine the level of risk it is willing to accept,” Hunt says.
Safety is the issue and Norix has the solution. All accessories are in easy-to-clean stainless steel. Pictured are: a toilet paper holder and soap dish in front-mount or chase-mount options, both recessed; security grab bar with safety gap-filler between bar and the wall; safety clothes hooks in single and 4-strip versions are not load-bearing.
Do you have suggestions on safety measures you use for furnishing patient rooms in your facility? Be sure to give us your feedback below!