The physical environment in psychiatric hospitals and other Behavioral Healthcare facilities plays a key role in patient safety. Some of those environmental risks are addressed by advancements in facility design, such as creating better sightlines for visual monitoring of patients, and the use of “security” glass in doors and windows. Other elements may be overlooked during the planning or construction phase, or may be inadvertently introduced at some later point where the necessary level of scrutiny may not exist. This is often the case with the selection and installation of furniture, fixtures and equipment (FF&E) in patient-occupied areas of behavioral healthcare facilities.
A new whitepaper from Norix Furniture details the difficulties assessing hazards, the flow of information, first steps, product usage, and the top five furniture considerations for patient safety in behavioral healthcare facilities. The information contained in the whitepaper was developed from an interview with James M. Hunt, AIA, President of Behavioral Health Facility Consulting, Topeka, Kansas. Mr. Hunt is a practicing architect and facility management professional with over 40 years of experience in healthcare projects. With his unique expertise, he assists psychiatric hospitals and behavioral health facilities throughout the U.S. Canada improve patient and staff safety, and consults with hospitals and architects on the design, building and remodeling of facilities. In addition to co-authoring the Design Guide for the Built Environment of Behavioral Health Facilities, he regularly publishes articles and speaks at major conferences. Below we will share those considerations for patient safety in behavioral healthcare facilities. For further details, download a printable PDF version of the white paper here.
1. Consider the product manufacturer
Look to manufacturers whose furnishings have a verifiable history in similar BHC settings, and assess if the company demonstrates a long-term commitment to the BHC sector. Assess if the product rep successfully demonstrates key safety and performance features as described in the Guide (or other authoritative resource). Determine if the manufacturer can substantiate marketing claims (there are no legal standards or certifications as to what “psych-safe” is, so work with a manufacturer you can trust). Ask what other facilities are using their products and visit a facility where products are in use. Consider if the manufacturer will be around down-the-road to offer replacement parts or make product modifications that may be deemed necessary in the future.
2. Select furniture according to each particular facility
The risks and conditions present in each facility deride the practice of rubber-stamping a given product list as a one-size-fits-all solution. The patient population, the patient care staff, as well as the type of institution and building design make a difference. What is manageable in one setting may not be in another. Hospitals that serve the self-pay patient generally want furnishings with a luxury feel – offering greater comfort and a stylish appearance, while still providing the same level of patient safety. Other facilities may have greater interest in maximizing durability rather than aesthetics. Visitation practices and settings may make the exchange of contraband more prevalent in a given institution, so tables and chairs in lounge or visitation rooms would need to be extremely tamper-resistant and without seams/gaps.
3. Examine actual furniture pieces to assess durability and performance in a given location
A catalog image or written description can’t convey a product’s construction quality or durability. Even with familiar and trusted products, the manufacturing process or material attributes may change over time, resulting in performance differences. Examine samples to determine if they would likely stand-up to rough use. Consider if the proposed table or chair were to be picked up and thrown, would pieces break off accidently, or could pieces be intentionally broken off creating anchor points or weapons? How much effort would it take for someone to defeat the safety feature/measure? If an item were damaged, could it be easily repaired or reupholstered and still maintain all necessary attributes?
4. Evaluate actual furniture pieces to assess injury risks
Even if a product is highly durable it can still carry potential risks for injury in a given setting. This is the case with some adjustable metal-framed hospital beds where patients could wedge an appendage between moving parts. Patients on BHC units may habitually work at a fixture or furniture part that could come loose and be ingested, leave a sharp edge, or allow the concealment of harmful contraband. With concerns regarding flammability, confirm that the products are certified to pass State of California, Technical Bulletin No. 133, Flammability Test Procedure for Seating Furniture for Use in Public Occupancies. (Local fire codes and other regulations may also apply.) Determine if furnishings can or should be securely anchored to the walls or floor, be ganged together or ballasted to deter lifting/throwing. Question if a cabinet or other heavy object could topple over and hurt someone or if a patient could climb on top of it to be able to reach something or to jump down on other people. In the Guide, Hunt recommends that patient room furniture be anchored in place with tamper-resistant hardware.
5. Consider the cleaning and maintenance requirements and practices
The cleanability and maintainability of BHC furniture affects patient health and safety with regard to hazards such as contamination from bodily fluids, the spread of air-born infections, and harboring of pests such as bed bugs. The makeup of the maintenance staff and the cleaning practices at a given facility also factor into the proper selection of materials and surfaces. Non-absorbent materials that won’t harbor bacteria provide the best protection against germs and diseases. For upholstered furniture, the new high tech fabrics are resistant to stains, liquids, and bacteria, but construction techniques need to be optimal. Consider if cushions can be easily re-covered or replaced. How quickly, how often, and with what products surfaces and materials are cleaned can affect long-term performance. Facilities with bedbug concerns might opt for one-piece molded furniture.
Making the right decisions about furnishings and fixtures to use in a mental health facility can have a great impact on patient health and safety. However, those carefully-considered choices can be undermined if the pieces themselves don’t last, or the products don’t offer the flexibility to contend with future renovations. Quality products that last and maintain a like-new appearance save the time and effort it takes to repeat the selection process over and over because of the need for replacements. Durability, as well as being able to mix-and-match or re-configure groupings can extend replacement cycles, providing greater continuity of standards and saving money.
For more information download: Top 5 Furniture Considerations for Patient Safety in Behavioral Healthcare facilities, or view all Norix Resources. And please share this post using the social bookmarking tools below.