Checklist for Assessing Environmental Risks for Suicide

The following is a brief checklist to help hospitals assess and address suicide risks in their ED, medical/surgical health units.

Does the space have “lay-in” ceilings? These can make it easier for the patient to hide contraband, can provide a

convenient place to secure a ligature for self-harm, or may allow the patient access to above-the-ceiling

interstitial spaces.

If the outside window of the room is operable, is the opening limited so a person could not pass through (4-6

inches is considered the architectural standard of care). Alternatively, consider protecting a window with a

security screen that is secured by a device that can be removed from the inside only with a special tool (such as a

non-common screw head).

Is the window glazing shatter-proof?

Is there a tamper-resistant, anti-ligature door knob for the patient’s room?

Is the power cord on the TV secured? A mounting bracket can be an attachment point for a ligature.

Have cork bulletin boards been replaced with dry-mark boards, thus eliminating inadvertent use of thumbtacks?

Is shatter-proof and tamper-resistant glass used in night lights and other lighting fixtures?

Are light fixtures secured to restrict patient access to bulbs and sockets?

Have grab bars been removed in the bathroom or wall “gaps” filled in?

Were coat hooks, towel bars, cubicle curtain tracks, and closet poles eliminated?

Are all electrical outlets GFCI (ground fault circuit interrupter) and tamper resistant?

Have all metal outlet covers been replaced with shatter-proof non-conductive covers?

Is the piping for the toilet and lavatory protected?

Are the lavatory faucets tamper-resistant?

Are the HVAC (heating, ventilating, and air conditioning) grills tamper-resistant?

Are theretamper-resistant shower controls and shower heads?

Is the mirror and picture glazing material considered shatter-proof?

Do mirrors, pictures and furniture have rounded edges and are secured to prevent use by patients in an aggressive manner to self, others and or staff?

Has all clothing, including belts and shoes with laces been secured?

Has the length of telephone cords been decreased to reduce ligature, potential for strangulation?

Have the types of eating utensils been assessed to decrease potential for harm and or concealment from staff?

Have all pens and pencils been secured to reduce potential for cuts and self-inflicted puncture wounds?

Does the space being used for patient care have recessed fire sprinkler heads?

Have cords on window treatments or blinds been removed to decrease ligature or strangulation potential?

Have you assessed trash cans? Plastic trash bags may present a suffocation hazard. Have plastic trash bags

been removed. Additionally, trash cans that are sturdy may be used to attempt hanging.

Have all room door hinges and handles been assessed with regard to potential barricade situations?

Are all fire alarm pull stations and fire extinguisher cabinets locked?

References
Guidelines for the Design and Construction of Healthcare Facilities. Facility Guidelines Institute; 2010
Sine DM, Hunt JM. Design guide for the built environment of behavioral health facilities: Edition 4.3, May, 2011

The Joint Commission, Sentinel Event Alert 46: A follow-up report on preventing suicide: Focus on medical/surgical units and the emergency department. Issue 46, November 17, 2010

Source
Adapted from Sine D.M.: Latent risks in the built environment for the behavioral healthpatient: Concerns for the healthcare risk manager. In The American Society for Healthcare Risk Management Handbook, 6th ed. Chicago: American Hospital Association, 2010.

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