Addressing Ligature Risks in the Patient Room and Beyond

(4/22/2024)

Patient suicide ranks among the top three sentinel events, reports The Joint Commission (TJC), bringing an intense scrutiny to ligature risks within healthcare facilities. TJC studies 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 for curbing suicides in healthcare settings. 

Patient suicide ranks among the top three sentinel events, reports The Joint Commission (TJC), bringing an intense scrutiny to ligature risks within healthcare facilities. TJC studies 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 for curbing suicides in healthcare settings. 

By the Numbers

• Suicide is the 11th leading cause of death in the U.S.
• Suicide is among the top three sentinel events (patient safety events resulting in death, permanent or severe temporary harm). 
• TJC estimates 49-65 inpatient suicides occur each year in the U.S. 

Given these statistics it’s easy to understand why surveyors are taking a hard look at ligature risks. It’s important for healthcare leaders to clearly understand what surveyors will be assessing when entering a facility. Some accreditation organization surveyors have gone to extremes to validate a point of view by hanging dental floss over a door hinge, saying, “that’s a ligature point.” Although an extreme example, accreditation organizations are being 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, to be corrected within 45 days or less. Given that the risk is literally people lives, ligature RFIs are never appropriate for time extensions, according to TJC.

Challenges Beyond the Patient Room

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. 

Ligature safety extends beyond patient rooms and requires comprehensive risk assessments, design solutions, staff training, and ongoing monitoring. By prioritizing patient safety and vigilance, healthcare institutions can create environments conducive to healing and recovery while mitigating ligature-related tragedies. Refer to The Joint Commission website for current recommendations and the latest updates.