Safety by design: Behavioral health patients

Hospital Safety Insider, June 2, 2016

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As you probably know as a healthcare safety professional responsible for the safety of your facility, times are changing, and to ensure the safety of your hospital, you have to change with it.

Hospitals have been seeing a steady increase in the number of behavioral health patients over the last 20 years or so. Some blame the closing of behavioral health facilities, others say substance dependence has a lot to do with it; whatever your take, the reality is that increasingly, patients with behavioral health needs are turning to your facility as their first choice when it comes to getting taken care of.

Fortunately, many hospitals have gotten the message that the trend won't be going away, and instead they will have to step up to meet the needs of the behavioral health patients while making sure their facilities remain safe. New hospitals are being designed with features that make the environment more comfortable, and some older hospitals that can't afford drastic overhauls are changing their triage protocols and making treatment rooms more flexible to help speed up the process of getting patients to a physician much quicker without unnecessarily long waits.

So what does this mean from a design standpoint? Well, it really depends on your situation, your budget, and the room you have. We're going to assume here that you don't have a huge budget, probably don't have a lot of room to grow, and like many hospitals, you and your staff do your best to keep up with a busy patient load, but worry about how to keep your facility and workers safe. With a few modifications of your current environment and protocols, you can improve the quality of treatment to your behavioral health patients while also improving security.

Decrease wait times. This is the kind of advice that can benefit any facility, since everyone hates to wait. Experts say one of the biggest factors behind violent incidents involving behavioral health patients is a long wait that increases anxiety. So why not take the stance that you're going to attack your wait times and decrease them? Something as simple as a digital clock listing wait times, something many hospitals are doing, can calm nerves.

Take a look at what is causing the backup in the first place. Chances are it starts in the triage area of your ER. Are your triage nurses and front-end staff overwhelmed? Maybe it's time to hire some extra help. Even better, perhaps it's time to get your triage staff out into the waiting room instead of making patients wait to be called.

Design flexible spaces
. The key to being flexible with your patients is to be flexible with your treatment spaces. If you have a behavioral health patient who needs a special room, and all your rooms are filled with equipment that they could potentially use to harm themselves, they'll have to wait until you can accommodate them, and that can lead to other problems. Why not redesign your rooms so that they can accommodate anyone?

Make the environment friendly.
Brighter environments make happier places. Many hospitals are creating behavioral health units, and more patient treatment areas in general, that boast high ceilings, open areas, and large windows that allow more natural light to come in. The result? Friendly, therapeutic places that calm patients and give a greater overall feeling.

What you do will depend on your space and budget, but picture behavioral health units with "wander space," to provide visitors, such as elderly patients with dementia or other behavioral health patients, a group area to walk off their energy as opposed to sitting around. Some hospital waiting rooms are being designed with a living room feel, with comfy furniture and fireplaces in some cases, as well as showers and video game areas to create a less-threatening environment for those who may be subjected to longer stays.

Train staff to respond to the right things. Your staff is going to be the first layer of protection for your facility in the event there is a violent incident, and they will also be instrumental in keeping it from escalating if they are properly trained.

The problem is, most workers in hospitals are not trained in de-escalation techniques and other self-defense strategies that could stop a small issue from becoming a major incident. Instead, experts say, they often let such issues develop into larger problems that can result in violent attacks and a response from security, giving the illusion of a police state and raising the likelihood of injuries.

Incorporate safe features. If you want to make your facility safer and more accessible for behavioral health patients, you'll need to start thinking about the things in your patient treatment rooms that make it dangerous for them.

Think about items such as plastic trash bags that can be used as ways to suffocate oneself, or high door hinges that can used as a means of hanging. Other dangers include glass in picture frames that can be broken and used as weapons, or needles, or anything else that can be used by patients to hit or hang themselves.

While no one likes to think of these scenarios, removing such items from the environment reduces the chance that they can be used in a violent incident, and at the same time, increases the number of rooms that you have available for all kinds of patients.

This is an excerpt from the monthly healthcare safety resource Briefings on Hospital Safety. Subscribers can read the rest of the article here. Non-subscribers can find out more about the journal, its benefits, and how to subscribe by clicking here.

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