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Based on observation, document review, and psychiatric staff interviews, the facility failed to establish and maintain a safe environment for 5 of 5 geriatric psychiatric inpatients.

Failure to establish and maintain a safe environment for psychiatric patients could potentially result in patient deaths or other life threatening conditions.

Findings include:

1. Observation on 3/19/13 at 9:37 AM, during the initial tour of the Geriatric Psychiatric Unit, with the Director of Inpatient Geriatric Psychiatric Unit, revealed 4 patient rooms each containing 2 beds, a restroom with shower, stool, and sink. The entry doors to the patient rooms opened inward and the restroom doors opened outward. Three visible hinges attached the door to the frame. Closure of the door revealed the exposure of the 3 hinges, to the patients residing in the room. The hinges (made of metal) extended approximately 1-inch from the doorframe. The extension of the hinges provided a sufficient area for the attachment of a hanging device and produced an unsafe environment in the patient rooms. The Director of Psychiatric confirmed the extensions of the hinges in to the patient rooms.

Additional observation on 3/19/13 at 9:37 AM, with the Director of Inpatient Geriatric Psychiatric Unit, revealed 4 of 4 sinks observed, in the patient bathrooms, contained non-break away faucets (ligature resistant) and lacked testing for weight resistance breakaway point with pressure applied. The faucet and the exposed plumbing provided sufficient area for the attachment of a hanging device. The Director of Psychiatric Unit confirmed the faucets and the exposed plumbing in the patient restroom.

Additional observation on 3/19/13 at 9:37 AM, with the Director of Inpatient Geriatric Psychiatric Unit, revealed handrails on both sides of the common hallway. The handrails were open to the back, allowing ample space for attachment of a hanging device. The Director of Psychiatric Unit confirmed the handrails were open to the wall.

Observation on 3/19/12 at 9:37 AM, with the Director of the Inpatient Geriatric Psychiatric Unit, revealed 4 of 4 patient rooms contained suspended ceilings above the patient beds. The ceiling tiles were easily pushed away to expose a wide-open area. The exposed metal bars used in the suspended ceilings provided ample space for attachment of a hanging device. The Director of Psychiatric Unit confirmed the suspended ceilings.

2. Review of facility policy titled, Patient Monitoring, dated 11/12, stated in part. It is the policy of Mahaska Health Partnership and the Behavioral Health Unit that to maintain the safety of each patient and the stability of the therapeutic milieu. Staff monitored all patients as to their location and activity at regular intervals. The Degree of this monitoring is dependent upon the individual patient's assessed psychiatric condition. The policy lacked specifics concerning the physical environment.

Review of facility policy titled, Unit Safety Guidelines, dated 11/12, stated in part. It is the policy of Mahaska Health Partnership and the Behavioral Health Unit that a safe and secure physical environment is maintained. Behavioral Health Unit staff will be familiar with and follow safety policies and procedures established by the Hospital's Safety Manuals to include internal and external disaster plans. These manuals should be on the Unit and easily accessible. All staff should be trained in all hospital safety procedures.

Review of a facility form titled, Behavioral Health Risk Assessment, dated 10/29/12, stated in part.

Concerns with:
-Continuous hinges used in patient accessible areas
-Doors swinging into corridors
-Exposed plumbing to sinks
-Sink Faucets that ligature resistance
-Additional comments/Actions, dated 12/12/12, stated in part.
Continuous hinges used inpatient accessible areas: Discussed rationale of hanging risk. Unit limits personal belongings and items. Shoelaces, belts, scarves, ties, etc are taken from the patient on entrance to the unit. The team felt this was effective in decreasing the hanging risk and changing hinges are not necessary for the geriatric population that they serve.
-Doors swing into corridors: This would not be compliant for the fire code.
-Doors have double-acting pivot hinges: Our doors only swing one way. Most patients need assistance with toileting and staff is with them.
-Sinks are close underneath: Ours are open. Piping is low to floor. Felt that the age and condition of the patients that we serve would not be a hanging risk from exposed sink pipes.
-Sink faucets are solid surface and push button water control: Our water is tempered to prevent burning. With the age of our population and the need for independence, we felt the knobs that we have are not a sufficient risk factor.

3. During an interview on 3/19/13 at 10:15 AM, Director of Facilities, revealed the faucets in the patient rooms lacked testing for weight bearing breakaway points. The Director demonstrated the ease of removing a suspended ceiling tile while standing on a ladder.

During an interview on 3/19/13 at 10:15 AM, Director of Psychiatric Unit, revealed the staff perform 15-minute rounding checks on all patients 24 hours each day, and increase monitoring as patient condition warrants. We have identified all of these areas of concern and have discussed making changes, but feel that our population is not at risk due to their age and physical conditions. We do not admit any one to our unit that is not over the age of 60. We have had no suicide attempts in the past 10 years.