How to spot suicide and ligature risks in your facility

The handles on the box springs of patient beds in residential areas. The caulking along the wall of otherwise-solid grab bars in showers. Any loops that might hold mattresses onto a bed frame. All of those and more have been cited as potential ligature risks by The Joint Commission and CMS surveyors in the last few months as they have stepped up inspections in the physical environment for suicide hazards in hospitals.

While last year The Joint Commission issued a Sentinel Event Alert to hospitals urging them to do a better job of identifying suicidal ideation in patients, this year the accreditor is doubling down, issuing specific warnings in Joint Commission publications and FAQs outlining concerns about ligature, or hanging, risks.

A complete reassessment of the physical environment of the areas where patients with behavioral or mental health problems are cared for could be in order, say consultants and accreditation managers with recent experience in the issue.

The Joint Commission warns that a finding of significant risk could spur a call for immediate threat to life (ITL), which could threaten your hospital’s accreditation. That and a renewed focus on the physical environment by CMS might require building or equipment changes, warns at least one consultant.

Even smallest risk is significant
Patients remain both creative and stubbornly persistent in finding even the smallest opening to self-harm that a hospital might leave behind in a treatment area or patient room. Often that small opening is quite literal.

 A nurse leader in accreditation and quality in a western U.S. behavioral health hospital warns against being lulled into a false sense of security even with physical features designed to mitigate suicide or other self-harm. The hospital had a near miss with a patient who took advantage of loose caulking along the solid metal plate fastening a shower grab handle to the wall.

After creating a hole, the patient then unraveled a thin but strong nylon thread from a piece of clothing and strung it through the hole to create a ligature. The patient was attempting to tie the other end of the thread around the neck when discovered.

The grab handle was the kind often recommended for areas where patients who might harm themselves are treated. No one on staff would have thought it possible “had we not seen it for ourselves,” says the manager, who asked that her name not be used. As part of the hospital’s sentinel event response, facility staff examined all the areas where such rails meet or attach to the walls and added caulking where necessary. Now they conduct regular inspections of the caulking to ensure it hasn’t begun to break down.

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