Patient bathrooms are the most dangerous spaces in a psychiatric inpatient unit. There is a great risk for suicide attempts, suicide completion, and tampering with hardware, plumbing and accessories to obtain weapons to harm oneself or others in this target-rich environment. It is also an easy place to be cited by regulatory agencies for patient safety and ligature risk issues. Such citations are costly, time-intensive and can put the entire hospital at risk of losing Medicare and Medicaid reimbursement capabilities. Many hospitals have been cited as an “immediate jeopardy to life” for ligature citations. 

When performing a patient safety risk assessment, professionals should consider ligature risk at all levels. Many people do not think about a ligature condition low to the floor, but any ligature point can put a patient at risk. Also, they should consider any item or condition that may provide the patient with a weapon with which to harm themselves or others. Becoming familiar with the latest products before reviewing the existing condition may help the reviewer see potential safety issues they may not have otherwise considered.

Once potential safety issues have been identified, professionals should carefully consider the best renovation option. They should begin by imagining the ideal solution. In many cases, budget or physical constraints make the ideal solution impossible. There are many ways to solve each condition within the available spaces and a wide variety of products with which to achieve those solutions. Product manufacturers can be very helpful, as can behavioral health consultants who are already familiar with the options. For each solution, professionals should consider not only the safety implications but also those for infection control, operational efficiency and quality of the therapeutic environment.

It is very expensive to renovate all patient bathrooms to the standard of new construction. However, due to the inherent risk of being in an unsupervised space, the patient bathroom is an important area of focus for patient safety and ligature risks and to consider retrofit options. The link in the box in the left-hand side of this column provides a tool intended to help facilities professionals make good decisions about psychiatric unit toilet room renovations.