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March 24, 2013

Tenth Anniversary Edition of

The Design Guide for the Built Environment of Behavioral Health Facilities

Free Download of the Tenth Anniversary Edition (March 2013) now available. click here

This Edition contains 114 pages of up to date information on products that are better for use in behavioral health facilities than items commonly used in general hospitals.  The Appendix has a total of 234 products.  Thirty-six of them are new listings that were not included in the November 2012 Edition.  The first edition in 2003 had 37 pages and featured 45 products.

David Sine and I wish to thank the NAPHS and especially Mark Covall, Kathleen McCann and Carole Szpak for their support and having faith in us and this project, without which this would not have been possible.

 

 

 

January 21, 2013

Keyless Cabinet Locks

Searching for the right key, handling it with gloved hands that may be contaminated and making sure the cabinet locks after it is closed are common issues related to cabinet locks in patient areas of behavioral health facilities.

There are several companies that have stepped up to help with these dilemmas.  CompX Security Products is one that offers a range of solutions to these common problems, at a range of different prices.

They start with the basic StealthLock that utilizes a pushbutton pad that communicates with the locks with wireless radio frequency technology.  The upper range has units that operate using proximity cards or magstripe cards that many facilities may currently be using for door access systems,   time clocks, etc.  Data capture of who opened the cabinet and when is also available and the information can be stored locally or via Ethernet connections.  Systems can unlock more than one door/drawer at a time and automatically relock them without staff needing to remember this important step.

Some of these systems can also control access to refrigerators, wardrobes, standard room doors and even walk-in freezers.

CompX products are domestically manufactured and are marketed under the four brand names: CompX National, CompX Fort, CompX Timberline and CompX Chicago.

 

December 21, 2012

Unequal Pair of doors swinging opposite No center frame member

Two previous blogs (8/8/12: Wicket doors and 10/21/12: Double-acting continuous hinges) have discussed different solutions to patients being able to barricade themselves into their bedrooms, toilet rooms, activity rooms or other areas. If the door to these rooms needs to swing into the room because of code requirements limiting obstruction of the corridor or to avoid creating alcoves that patients could use to hide, then barricading is an issue.

Another option is to provide two doors at the entrance to the room from the corridor. One door is for normal use and the other for emergency use only. This is usually termed a “double egress” door. A more typical use of this type of door are the cross-corridor doors in smoke or fire separation partitions. In this use, both doors are the same width.

In this application, the door for normal use is the required width for access (usually 36” to 48” depending on the circumstances and code requirements) and swings into the room. The other door can be more narrow (18” to 24”) and swing out into the corridor when needed for emergency access. This will require a minimum of 5’-0” of corridor wall in the room to accommodate the width of this assembly, which can be a difficult issue in remodeling projects. This smaller door should have no exposed hardware on the room side and only a deadbolt cylinder and continuous hinge on the corridor side.

One way to do this is to provide a door frame that is specifically designed for this application and has a vertical frame member between the two doors. These are available as standard products from several manufacturers or are available by special order from any good door frame shop. These allow the use of hardware that is more typically used on these units.

If additional clear opening width is desired to move equipment into the room (or for other reasons) this can be done without a vertical frame member between the two doors. This is a little more difficult to design and requires more specialized hardware. It also may result in more noise being generated in the normal use of the door.

SUMMARY – If space is available in the corridor wall of the room, the unequal pair of double egress doors solution is a very good way to address the potential risk of patients barricading themselves in rooms to avoid staff intervention.

 

 

 

 

 

November 21, 2012

NEWS RELEASE

UPDATED 5.2 EDITION (NOVEMBER 2012) OF THE
DESIGN GUIDE FOR THE BUILT ENVIRONMENT OF BEHAVIORAL HEALTH FACILITIES

NOW SEARCHABLE!!!!

FREE DOWNLOAD HERE:
NAPHS Design Guide Edition 5.2 November 2012

(Washington, D.C., November 28, 2012)…..As new products have become available to assist psychiatric and addiction treatment facilities in improving safety, the authors of a highly regarded reference guide on the built environment in behavioral health facilities have issued an updated (5.2) edition of this online resource. Design Guide for the Built Environment of Behavioral Health Facilities: Edition 5.2 includes indexes to help locate resources by product description and by manufacturer. The updated guide is available free on the Web site of the National Association of Psychiatric Health Systems (NAPHS) by clicking the link above.

Written by national experts James M. Hunt, AIA, NCARB, and David Sine, ARM, CSP, CPHRM, the publication identifies specific items and manufacturers (with model numbers and photographs) to explain why hundreds of resources (from door levers to security glass) are appropriate for use in the behavioral healthcare setting. The document was first issued in 2003 as Guidelines for the Built Environment of Behavioral Health Facilities and reissued in subsequent editions between 2007 and 2012 as the Design Guide. The 5.2 edition of the guide is intended to help those who are involved in caring for patients within an existing behavioral healthcare program as well as those designing a new building or renovating space. The text is searchable (using CTL+F).

“NAPHS is pleased to make this practical resource from experienced safety experts available to the field at no charge,” said NAPHS President/CEO Mark Covall. “NAPHS does not endorse or recommend any specific product, nor does exclusion of a product indicate disapproval. However, we believe that it is important to share ideas that can help in the process of continuously enhancing patient safety and improving patient care. Previous editions of this publication have been extremely well received by the field, and we appreciate the authors’ efforts to incorporate new products and thinking into the updated 5.2 edition.” The document is not intended as a legal standard of care that facilities are in any way required to follow. Download a free copy of the guide at www.naphs.org or click the following link:Download Design Guide 5.2

ABOUT THE AUTHORS
James M. Hunt, AIA, NCARB, president of Behavioral Health Facility Consulting, LLC, in Topeka, KS, is a registered Architect and facility management professional with more than 30 years experience. Among other things, he served as director of facilities management for the Menninger Clinic for 20 years and was a founding member and past chair of the Health Care Council of the International Facility Management Association. David Sine, ARM, CSP, CPHRM, president of SafetyLogic Systems in Austin, TX, is an expert in safety, risk management, human factors, and organizational consulting. He serves as a member of the NFPA 101 Life Safety Code Subcommittee on Health Care Occupancies and The Joint Commission Committee on Healthcare Safety.

ABOUT NAPHS
The National Association of Psychiatric Health Systems (NAPHS) advocates for behavioral health and represents provider systems that are committed to the delivery of responsive, accountable, and clinically effective prevention, treatment, and care for children, adolescents, adults, and older adults with mental and substance use disorders. Its members are behavioral healthcare provider organizations that own or manage more than 700 specialty psychiatric hospitals, general hospital psychiatric and addiction treatment units and behavioral healthcare divisions, residential treatment facilities, youth services organizations, and extensive outpatient networks. The association was founded in 1933.

October 21, 2012

Double Acting Continuous Hinge

Pemko Double Acting Continuous Hinge in closed position

A new double acting continuous hinge is now available as a barricade resistant solution.

Pemko has released this hinge which provides 100 degrees of swing in the normal direction and 90 degrees in the emergency swing direction.  It can be electrified for use with door alarms, electric locks and other electrified hardware and is still a ligature resistant hinge.

 

These will allow doors to typically swing into rooms such as patient rooms as well as Group Rooms, Activity Rooms and other rooms in which patients may have the opportunity to barricade themselves.  These hinges may be used with existing door frames (may require some modification) as long as the minimum required clear opening width can be maintained.  This hinge does reduce the clear opening width by 2 ¾”.

 

Door Stop in Typical Position

The companion operable stop extends the full height of the door for both security and to close the gap between the edge of the door and the frame.  It securely locks in place with a key and is mounted on a continuous hinge so it easily swings out of the way for emergency operation and swings back into position and relocks after the emergency passes.  A rabbeted stop or applied channel may required on the strike jamb to

allow the operable stop to swing out of the way of the door when swinging out into the corridor depending on the position of the door in the frame.

 

This, and other double acting continuous hinges, is easier to install and adjust than center pivot hinges and provides fewer ligature attachment points.  The gaps at both edges of the door are covered to provide better sound control as well as light and visibility resolution without add on strips that may become ligature hazards.

 

 

 

Weizel Security 817-S59 Safe Support Maryland Toilet Paper Dispenser

September 14, 2012

New Toilet Paper Dispenser – fully enclosed

All of the toilet paper dispensers currently listed in the NAPHS Design Guide for the Built Environment of Behavioral Health Facilities allow the patients access to the entire roll and some require users to handle the roll. Infection Control programs sometimes disapprove of the recessed cylinder type dispensers that require the entire roll to be removed by the user. Maintenance Departments are typically concerned about patients using the rolls of toilet paper to clog toilet fixtures and flood the rooms.

Securing Hospitals has developed a new toilet paper holder based on a concept originally created by the maintenance department of the Good Shepherd Center in Baltimore, Maryland. This newly released toilet paper dispenser (designated 817-S59 SafeSupport SR Maryland TP Dispenser) addresses both of these common concerns. It is a fully enclosed toilet paper dispenser for use in behavioral health patient accessible toilet rooms. It fully contains the roll so that it remains shielded from patient contact. The enclosure is made of powder coated, heavy gage steel and the potentially sharp outside edges are eased to provide an added measure of safety. The paper is pulled out of the bottom of the dispenser through a diaphragm that is designed to assure that the paper always tears off outside the dispenser. The design resists hiding contraband inside the dispenser and makes it difficult to remove large amounts of paper at one time.

For more information, contact Weizel Security, 800-308-3627 or www.securinghospitals.com

click here for video demonstration 

 

August 8, 2012

A Better Looking and more durable patient room wicket door

Patient Room Doors play a significant role in the visual ambiance of inpatient units as addition to the important physical function it serves.

First, let’s discuss the visual impact of these doors before addressing the physical aspects.

The Patient Room Doors have an impact on the aesthetics of the unit corridors as well as the Patient Rooms themselves. They comprise a significant part of the surface area of the corridor walls. While I do not agree that wood grain necessarily equals residential appearance, it does have a tendency to be less institutional and sterile looking. Stainless steel kickplates are often used to protect the easily damaged finish of wood doors that typically have a very thin veneer. These kickplates or even taller protective stainless steel armor plates greatly reduce the visual benefits of the wood appearance. There are kickplates available that are made from durable plastic materials in a range of colors that soften the visual impact, but still look like a patch on an otherwise attractive door.

One solution is to make all exposed surfaces of the door out of the more durable material which can also have a wood grain appearance. This not only eliminates the need to surface apply panels to take the abuse, it provides easily replaced vertical edge pieces which are also vulnerable to damage. At one time, the cost of these doors was an obstacle for some projects. If one considers the cost of a wood door, finishing the door and adding protective kickplates and other possible protective cladding including labor to install them, these are becoming more comparable on a first cost basis.

Codes and regulations also have a lot to say about Patient Room / Corridor Doors. These requirements often result in tight fitting doors that need to swing into the patient rooms to avoid either restricting the Corridor width or creating alcoves in which patients can hide. In-swinging doors have the potential of being barricaded by patients to keep staff from entering the rooms. One solution to barricading is to provide a door-within-a-door sometimes known as a “wicket” door.

 

These provide a locked cutout in the center portion of the door which is hinged to swing out into the corridor to allow staff entry if the door is barricaded. The edge of the cutout portion should not provide an open sight line through the door. Either a notched profile of the cutout edges or an applied astragal is needed. Invisible SOSS type hinges are preferred, but a geared continuous hinge is sometimes used if its appearance is deemed acceptable. A locking device for the cutout is needed and varies from a keyed deadlock to a recessed cam lock that can be released with a pinned torx key or similar device. The last piece of hardware needed is a pull of some type to assist staff in pulling the cutout open. The choice of the pull to be used will vary with the hospital’s preference between minimizing the visual impact of the pull and the amount of grip that is desired.

One solution to all of these elements of the Patient Room / Corridor doors is Acrovyn Doors by Construction Specialties, Inc. They can provide a variety of durable appearance options and a selection of choices in the wicket door design and hardware to suit the needs of many projects.

June 22, 2012

Lightweight Chair with 300 Pound Rating

I often suggest the use of a lightweight plastic chair for moveable patient seating in patient bedrooms, dining rooms, etc.  These are durable, don’t break easily and do not make very good weapons for breaking windors or assulting others.

Some facilities have commented that these are not sturdy enough, expecially for geriatric patients and will not support heavier patients or adolescents that like to lean back on two legs of the chair.

I recently became aware of a chair that may resolve these issues.  It is the RazorBack chair by Cortech.  The manufacturer recommends this for patients up to 300 pounds.  It has actually passed the ASTM F1561-03 drop weight test to 400 pounds and withstood an informal static load test of 1,500 pounds.  It has also passed the Cal 133 flame retardant test.  It is stackable and available in a variety of colors.

As always, I have no financial of other interest in this or any other product that is featured here or in any of my publications.

For contact information, please see Products Section of this website.

 

May 17, 2012

ROLLER LATCHES ARE COMING BACK!!!

The newly released 2012 Edition of the NFPA 101 Life Safety Code has a provision that allows roller latches on Patient Room to Corridor Doors in psychiatric hospital inpatient units.

Therefore, concerns about ligature attachment to the various levers, paddles, etc. becomes a non-issue.  All that is needed under this new requirement is a recessed pull on both sides of the door.  Of course, this would not be ADA compliant, but neither are the tapered knobs and some of the other ligature resistant hardware.

HOLD ON, before the parade gets started, it will take some time before CMS, building codes and “Authorities Having Jurisdiction” get on board and roller latches can actually be used, but this is a great first step.

 

 

April 18, 2012

James M. Hunt is also a Regular Contributing Blogger on the

Behavioral Healthcare Magazine Website at www.behavioral.net

In addition to his Blogs here, James M. Hunt, AIA is now also a Regular Contributing Blogger on the website of the Behavioral Healthcare Magazine.

His Blogs there will focus (at least initially) on attempting to explain why some of the “sacred cows” of Behavioral Health Care Design are not valid.  These often are used as “reasons” to not provide needed precautions and may result in creating environments for patients and staff than are more hazardous than they need to be.

At the present time, his blogs here will look into newly available products that may help provide a more save environment for patients and staff.

In both locations, readers are encouraged to comment on the subject and agree or disagree on the stated opinions.  A healthy discussion of differing opinions often increases all open minded participants’ understanding of the issues.

March 23, 2012

TOO MUCH STAINLESS STEEL IN YOUR PATIENT TOILET ROOMS?

 Many facilities are now trying to eliminate as much stainless steel in their Patient Toilet Rooms as possible.  They feel that this is one way to reduce the “institutional” appearance of these rooms.  I agree.  Fortunately, many products (especially toilet accessories) that were once only available in stainless steel are now available with a powder coated finish.  This is a very tough baked on paint finish that is available in a variety of colors.  Even some stainless steel toilet and lavatory fixtures are now available with powder coated finish.

Some manufactures are now offering their products in other materials than stainless steel.  One example of this is that the Bradley Corporation will soon have a high impact plastic trap cover for the HSL1 SafeCare™ Ligature Resistant Single-Station Lavatory in the next few months.  It will be available in both beige and gray.  Please note that this lavatory (Item #540) was identified incorrectly in the Appendix of the current edition of the “Design Guide”.

 

February 29, 2011

GIVE PATIENTS THE ABILITY TO LOCK THEMSELVES INTO THEIR ROOMS???

This has been absolutely unthinkable for many years. We would never have done such a thing in the past. However, incidents of sexual attacks by male patients on female patients recently have some facilities looking into ways to do this without severely restricting staff from getting into the rooms quickly when needed or for routine bed checks.

The VA hospital system has been looking into this problem and one possible solution has been developed by Stanley Security Solutions. It is appropriately named the Female Patient Privacy Lockset. This device provides a ligature resistant turnpiece on the patient room side of the door for the patient’s use. A typical lock cylinder is provided on the corridor side of the door for staff to use to gain access to the room.

One concern was that patients might insert object such as tightly rolled paper or a tine broken from a plastic fork into the cylinder’s keyway to slow down staff members’ ability to get into the room. To help reduce this risk, a “Cylinder Protector” is also available from this manufacturer that provides a sliding cover over the cylinder that is released by using a specially shaped magnetic “key”.

For times when there is not a perceived need for the patient occupying the room to have the ability to lock the door, or other clinical considerations make it undesirable, there is a removable device that simply attaches with a tamper resistant screw to disable the turnpiece on the patient room side of the door.

Now there is a way to help protect patients and let them feel more secure in their rooms while still retaining the all important access for staff.

For more information on this hardware go to http://www.bestaccess.com/products/behavioralhealthcare.asp

FEBRUARY 10, 2012

NEW EDITION OF THE DESIGN GUIDE FOR THE BUILT ENVIRONMENT OF BEHAVIORAL HEALTH FACILITIES IS NOW AVAILABLE!

A new edition of the Design Guide for the Built Environment of Behavioral Health Facilities has been ublished by the National Association of Psychiatric Services and is available for download here, Design Guide 5.0 – Feb. 2012.  This is Edition 5.0 and marks the twelveth revision of this white paper that was originally posted in 2003.  It is available free of charge via download as a service to the industry in an attempt to provide current information regarding products and philosophies that are better for use in psychiatric hospitals and behavioral health facilities.

I have the privilege of sharing the duties of authoring this document with David Sine, the president of Safety Logic Systems.  It is a compilation of our combined sixty years of experience in designing, facility management and risk management of these facilities.  We are also aided by many individuals active in the field with their comments regarding what does (and doesn’t) enhance patient and staff safety in these facilities.

This Edition 5.0 introduces a new organization and numbering system for the products that allows similar items to be grouped together for easier comparison and the Appendix now also has images of many of the products to help users quickly identify items and Indexes are included that are sorted by both type of product as well as manufacturers.