Four ways to address ligature risks in patient rooms and beyond

John Trotta
Vizient Senior Consultant, Facilities and Construction Solutions

According to The Joint Commission (TJC), patient suicide attempts rank among the top three patient safety events resulting in death, permanent harm or severe temporary harm, bringing intense scrutiny to ligature risks within healthcare facilities. Through its studies, TJC — which estimates between 49 to 65 inpatient suicides occur each year in the U.S. — suggests that suicide prevention efforts in hospital settings should focus primarily on reducing the risks of death by hanging. It stands to reason that if many suicide attempts are impulsive, then reducing environmental risks and opportunities for self-harm is vital to curb suicides in healthcare settings.

Given the statistics, it's understandable that surveyors are taking a hard look at ligature risks. It's important for healthcare leaders to be aware of what surveyors will assess when they inspect a facility. In some cases, accreditation surveyors have even noted ligature points by hanging dental floss over door hinges. Although an extreme example, accreditation organizations are meticulous, so healthcare facilities must be prepared for intense scrutiny around potential ligature points.

Any ligature risk, no matter how small, is an immediate Recommendation for Improvement (RFI) when observed in an inpatient, psychiatric or designed area (a hospital space that accommodates patients with mental health issues/disabilities), and must be corrected within 45 days or fewer. Ligature RFIs are never appropriate for time extensions, according to TJC, due to the risk of life.

Challenges beyond the patient room

In behavioral health hospitals, ligature assessments extend beyond the patient room to common areas, grounds and hallways, as patients in these specialty hospitals are often outside of their room. While patient rooms are focal points for ligature risk mitigation, assessment requires a multifaceted approach involving collaboration among stakeholders and adherence to best practices, including:

1. Comprehensive risk assessments
   Conducting thorough assessments of physical environments is foundational to identifying potential ligature points. Engaging stakeholders, including facility staff and architects, and partnering with safety experts, enhances the accuracy and effectiveness of risk evaluations.
2. Implementing design solutions
   Integrating ligature-resistant fixtures and furniture mitigates risks and enhances safety across diverse settings. From tamper-resistant door hardware to breakaway showerheads, investing in design solutions tailored to specific environments bolsters preventive efforts.
3. Staff training and awareness
   Equipping staff with comprehensive training on ligature risk recognition and response is critical. Empowering personnel to identify warning signs, intervene effectively and communicate concerns fosters a culture of safety and vigilance.
4. Ongoing monitoring and evaluation
   Continuous monitoring and evaluation of ligature risk management protocols are essential for maintaining effectiveness and addressing emerging challenges. Regular audits, feedback mechanisms and incident reporting facilitate proactive interventions and continuous improvement.

By prioritizing patient safety and vigilance, healthcare institutions can create environments that promote healing and recovery while mitigating ligature-related tragedies. Refer to The Joint Commission website for current recommendations and the latest updates.

Learn more about healthcare accreditation services offered through Vizient.

Author

John Trotta is a senior consultant on Vizient's Facilities and Construction Solutions team. He earned a B.S. in industrial management and has nearly 30 years of experience in construction, facility management and supply chain.