For years, hospitals have seen Joint Commission inspections of their psychiatric units as important and stressful, but no more so than any other part of the hospital. Those days are gone. The Joint Commission has put a new emphasis on safety in psychiatric environments—an emphasis that is creating positive change in many facilities and creating uncertainty in clinical and facilities staff.
One administrator/nurse who has been working with psychiatric patients for over 30 years recently told me she was tearing her hair out over the latest inspection. All manner of things were pointed out as a hazard that she felt were unreasonable based on her years of experience—although she did acknowledge that they would have to find a way to change it or get cited.
The Joint Commission means well, and I applaud its focus on this important topic. The commission absolutely is correct to say that suicides in inpatient settings cannot be tolerated and more must be done to stop them. They have even spent the time to establish guidelines on common elements that may or may not constitute a hazard to help guide their inspectors and clients. Unfortunately, many conditions are unique and require an evaluation on site of the specific instance. That puts an inspector in a very difficult situation. Given the emphasis on safety, we are seeing inspectors err on the side of caution and cite an item if they think it could possibly be an issue. This is leading to a lot more “corrective” work in these units than hospital staff are used to.
So, what can you do? Throw your hands up and get mad? Sure, for the first five minutes. After that, though, it’s time to acknowledge that everyone is trying their best to do the right thing and find a way to work through it. Following are a few strategies for solving difficult problems:
- Mitigation plan. If an inspector is pointing out a potential hazard that has not been a problem in your facility, think about why it hasn’t been an issue. The odds are that you have, intentionally or unintentionally, developed operational procedures that minimize that risk. Write it down and make it available to the inspector so they can understand how you are managing it. Staff are still the most important element of safety!
- Call an architect. You may know everything there is to know about your facility, but architects have the advantage of seeing many facilities, hearing from many clients and seeing what many inspectors are citing. If you hire one with extensive experience in behavioral healthcare, he or she can help you find creative solutions.
- Security sealant. That might sound tongue in cheek, but it isn’t. Security sealant, often known as pick proof caulk, is the duct tape of psychiatric security. When I review an older unit, about 50% of my recommendations are to apply a layer of pick proof caulk. Look at every sharp corner, extended ledge or removable object, and ask yourself if it would still be an issue if you caulked the perimeter with security sealant.
The new Joint Commission emphasis is here, and it isn’t going away. The better prepared you are to deal with it, the smoother your transition will be.