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Design mistakes, part 2: More things many 'know' that 'just ain't so'

By: James M. Hunt, AIA, NCARB | This article was originally published in Behavioral Healthcare Executive.

Editor’s Note:  In the design article in our November/December 2012 issue, consultant Jim Hunt introduced Part 1 of a discussion of common, but mistaken design and safety-related assumptions that often emerge in preliminary design meetings that precede the development or renovation of a psychiatric facility. Part 2 of his discussion, beginning with his third point, begins below.     (3.) “15-minute checks provide sufficient observation for patients on suicide watch.” This is a widely held concept that has been around for decades. But it must be challenged, because it is not backed by evidence.

I would suggest that a designer start a discussion with this question: “Why do you think that checking on patients at 15-minute intervals is an effective suicide deterrent?” Typical responses may note that an individual could not accomplish a suicide by strangulation or suffocation in that period of time.

But that is not the case: Medical studies verified by The Joint Commission3 establish that patients can tie something around their necks tightly enough to cause death or irreparable brain damage in as little as 4 to 5 minutes by inducing a condition called anoxia. Another study4 also concluded that 15-minute checks do not prevent suicides. It is clearly possible for patients to “time” suicide attempts between checks.

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