Ligature-risk requirements

Separating fact from fiction in suicide prevention, Health Facilities Magazine (Dec. 2018)
BY CHAD BEEBE, AIA, CHFM, CFPS, CBO, FASHE

Few events in health care facilities are as catastrophic — and preventable — as a patient suicide. Yet data indicate that suicide incidents are a serious problem, which suggests that hospitals must do a better job not only of identifying and monitoring patients at risk but removing the means to accomplish suicide in the physical environment.

The facts are sobering: The suicide rate has increased more than 25 percent nationwide from 1999 to 2016, per a recent Centers for Disease Control and Prevention (CDC) report, which also found that 54 percent of those who died by suicide in that period did not suffer from a mental health condition. According to the CDC, suicide is now the 10th leading cause of death in the United States, taking more than 40,000 lives a year. The most recent data published by the National Violent Death Reporting System (NVDRS) reveals that, in 2015, 83 suicides occurred in medical facilities.

The vast majority of these inpatient suicides have resulted from hanging, most commonly in a bathroom or bedroom and often using a door or its handle or hinge; a head, handle, bar or door in the shower; a ceiling or sink pipe; or another type of fixture as the ligature fixation point. Logic dictates that eliminating these and other ligature risks from the environment of a patient with suicidal ideation is necessary. Standards and requirements by accrediting organizations mandate as much. But the truth is, many health care organizations are misinterpreting the requirements for reducing ligature risk. Others mistakenly believe that new ligature-resistance rules have been put into effect, which is not accurate. And plenty suffer from the misconception that eliminating ligature points is the only effective solution. In reality, decreasing ligature risks isn’t practical in many hospitals. Additionally, it’s not the best or sole option. The key to more successfully preventing suicides is for health care organizations to change their way of thinking about this issue. They need to realize that ligature resistance is secondary to a more important priority: providing continuous one-to-one (1:1) observation of any patient with suicidal ideation.

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