Opening doors to patient safety

For patients at risk for self-harm, ensuring safety can be difficult. Since the majority of suicide attempts involve using makeshift ligatures to hang from doors or door hardware, the entrance to any room is a key consideration for mental health facilities. 

Fortunately, the industry has taken a much more proactive approach in recent years. This has led manufacturers to introduce a variety of new anti-ligature (or “ligature resistant”) locking solutions and door hardware, which are designed to make suicide attempts much less likely to be successful.

Even then, there is no “perfect solution,” according to Mark Berger, president and chief product officer at Securitech Group, Inc., which partners with Stanley Security Solutions in the behavioral healthcare market. “Every product is simply better than what existed before-and one more tool to assist the staff.”

Unconventional thinking

Of course, conventional door hardware isn't designed with any considerations that would help prevent something like a suicide attempt. But in a mental health environment, it's important to take a slightly different approach-even when it comes to something as simple as a doorknob.

While anti-ligature hardware can be installed on brand new doors, many facilities still choose to retrofit to existing doors. But it can be a challenging process, according to Rodd Salvatore, sales engineer for Accurate Lock & Hardware Co., because once you really start looking, “you have to rethink everything.”

“Originally, existing [doors and hardware] weren't designed to prevent suicide attempts, so conventional wisdom just doesn't hold up,” says Salvatore. “Often you end up solving one problem only to create another, so the trick is to find the balance without giving up too much on either end.”

To find the balance, manufacturers work closely with facility personnel. Product development is guided by insight from patient safety coordinators, nurses, doctors, and facility engineers, many of whom provide step-by-step scenarios to illustrate the potential for self-harm.

Berger explains: “An administrator will tell us: ‘Okay, you've removed the lockset as a ligature point. The next thing the patient will do is take their bed sheet, tie a knot at one end, throw it over the door, close the door, and attempt to harm themselves that way.’”

In addition, aesthetics are playing an increasingly important role. To some extent, door hardware manufacturers are moving away from products that have the “foreboding” appearance of a detention center toward those that make patients feel they are in a therapeutic environment.

“It's actually quite remarkable how the industry has responded [to deinstitutionalizing different aspects of facility design],” notes Berger. “We have gone from sterile designs to code-compliant solutions that meet the needs of patients as well as safety professionals.”

Product developments

For years, lock manufacturers made conical safety knobs for use in mental health facilities. However, with the rise of ADA regulations in recent years, it's no longer enough for products to provide sufficient safety controls. They also have to be ADA-
compliant.

“With stricter enforcement and a number of sentinel events, the pendulum shifted,” says Salvatore. “When facilities felt pressure to comply, manufacturers started introducing conical safety levers and that solved the problem.”

Stanley Security Solutions offers emergency door alarm sensors, which notify nurses when pressure is applied to the top of the door.

Conical safety levers feature a conical section that comes off the door, rounding into a tapered lever. Because rigid levers become potential ligature points, it's important for levers to be “free moving” in a mental health environment.

According to Berger, Stanley's approach involves having a key that locks the door, but disconnects the lever from the lockset. “The lever can move, but it no longer retracts the latch on the lock,” he explains. “This provides the same effect of locking the door, but with a lever that's never rigid.”

Stanley also offers emergency door alarm sensors, which notify nurses when pressure is applied to top of the door, as well as “piano-type” hinge arrangements that cover the entire gap between door and frame. In addition, a “slip-clutch” feature prevents patients from jamming the turnpiece in order to keep staff from entering.

“We look at the whole door in our approach of how to prevent patients from harming themselves,” says Berger. “It's a holistic approach to the entire opening between the lock set, the sensor bar, and the hinge-and how they all work in concert.”

Accurate Lock & Hardware has introduced a dimpled safety knob and lever clutch safety mechanism, in addition to a crescent handle hybrid, which Salvatore says “offers all the attributes of anti-ligature hardware, but is still ADA compatible.”

The solid crescent handle of this hybrid hardware design, introduced by Accurate Lock & Hardware, offers all the attributes of anti-ligature hardware, plus ADA compliance.

As one would imagine, testing safety hardware is a rigorous process because design errors can't be tolerated. “Errors become safety issues,” notes Salvatore. “One error can allow a string or cord to get in between a space and facilitate someone harming himself.”

According to Salvatore, hardware mockups are used to help product testers imagine and address conceivable methods of self-harm. The process also involves a third-party consultant that “takes strings and phone cords and does all sorts of different things to try to defeat the products,” he says.

Accurate's latest product uses keyless entry, via electronic, wireless card-readers. Modified to incorporate antiligature hardware on both sides of the door, the system provides a valuable tool for head nurses. “It ensures that rooms are properly checked, and for liability purposes, provides verification that those activities are taking place,” explains Salvatore.

Newfound privacy

Ensuring privacy can be complicated when patients may be at risk of self-harm. However, the issue has been given new consideration recently, prompted (at least in part) by an initiative from the Veterans Administration that allows female patients to be housed in wards that traditionally have been male.

“Essentially, the [VA] wants female patients to be able to secure themselves within their room, but also allow staff to enter at all times,” explains Berger. To meet the demand, Stanley modified its ligature-resistant patient safety lever with a special privacy function, which added a new conically designed, recessed turnpiece.

“We designed this function not only to provide the ligature resistance and [anti-lockout features], but also in a way that “didn't look frightening yet gave the patient some degree of control,” Berger says.

Regardless of gender, patient privacy is one aspect of the industry that will continue to get more attention in the future, Salvatore agrees.

“Ultimately, patients shouldn't feel like they're in an institution, but rather in a living environment-and part of that is giving them the privileges of privacy,” he says. “Of course, it needs to be tempered with the fact that there are overrides. Personnel always need to be able to access their patients.”