Designing Inpatient Rooms for Use in Behavioral Health
During Part 1, I introduced the topic of designing inpatient environments for comorbid conditions. We discussed the importance of the observation plan in relation to design. In this section, we discuss the issues relating to medical equipment planning in behavioral health design for inpatient rooms.
Wall Mounted Equipment
Both medical and IT equipment are interesting considerations for a behavioral health room. As mentioned previously, wall mounted equipment typically located on the headwall (diagnostic set, physiologic monitor, etc.) is often placed behind hidden behind roller or “garage” doors that can be closed when the room must be secured (a good example of modifiability). Another solution we’ve seen for the headwall is to recess the wall mounted equipment and place it behind lockable doors that are flush with the wall.
However, not everything can be located on the headwall. A good example is the television. Ideally it is placed on the foot wall for comfortable viewing, and therefore would not be a candidate for hiding behind roller doors. A traditional mount presents a ligature risk and also introduces additional outlets and cables that need to be secured. To address this risk, we turn to the wide selection of lockable cases (Cape Cod Systems, ProEnc, TV Armor), with customizations available specifically for mental health environments. In the UCHealth AIP2 Clinical Observation Unit, which opened in April 2019, the televisions were recessed into the wall and custom designed cases were used to secure them.
A critical piece of equipment to address is the patient bed. Unless the unit’s primary purpose is behavioral health, standard behavioral health beds are not likely to meet the requirements for patient care. They do not raise or lower and are not mobile, which causes problems for code responses. There are electric hospital beds (Sizewise, Stryker) which are specifically designed for use on behavioral health units. These are meant for use with patients with comorbid issues and are designed with tamper-resistant features. However, they do have significant ligature point risks, since they have guardrails and many hazards beneath the bed. Depending on the facility’s rental agreements, it may be possible to rent these beds on an as-needed basis, much like many facilities do with bariatric beds.
In the UCHealth AIP2 Clinical Observation Unit, the decision was made to use the standard stretchers present in their ED. The reasoning is that stretchers are easily removed when an anti-ligature environment is needed. Since the unit is an extension of the ED, it is not designed towards long-term patients and the lack of a sleeping surface is a temporary inconvenience. For a long-term patient, use of 1:1 observation could allow for the bed or stretcher to remain in the room.
Mobile equipment is a viable option that is frequently used in medical equipment planning for behavioral health areas. When a roller door or recessed enclosure is not desirable, or the roller door is closed, equipment such as physiologic monitors, sphygmomanometers, thermometers, and charting computers can easily be placed on mobile carts. This way, equipment can be rolled into the room as needed exposing the caregiver or the patient to potential dangers.
Some items are mobile, but do not make sense to remove from use. One example of this is the trash can. Plastic liners present a suffocation hazard. The Behavioral Health Design Guide states that plastic trash can liners should not be allowed in any space accessible to patients. Breathable paper liners are presented as the alternative. In the UCHealth AIP2 Clinical Observation Unit, a 1.5-gallon trash can was selected for the patient rooms. This small can was chosen to fit the small paper bags that they chose for their liners.
Another important consideration is supply storage. Depending on the purpose of the unit, a large variety of consumables and small equipment can be required. Mobile supply carts are a good option that can be removed from the patient room when necessary. You can also use supply carts to decrease the number of items mounted to the walls, such as sharps disposals and glove box dispensers. Small equipment, such as thermometers, can be placed in one of the drawers and a charting computer can be placed on top of the cart.
Not all items are practical to be on mobile carts and must be accessible, in which case anti-ligature options are needed. For example, soap and paper towels should be available next to the sink. Although anti-ligature dispensers are readily available on the market, a dispenser that will fit the same soap and paper towels as the rest of the unit. EVS will thank you later!
As mentioned earlier, observation can mitigate many risks and several of our clients have decided to rely on 1:1 observation for behavioral health patients. In those cases, all rooms were outfitted identically. It was determined that the frequency of situations requiring a special room would be low enough that the staff could handle the extra load that 1:1 observation would create.
It is easy to get caught up in the details of design, but it is always important to keep the purpose of the space at the forefront of every decision. Whatever additional requirements have been added, the space must always match the basic purpose. The final product must meet the needs of the patient and caregiver, both on paper and in practice.
Medical Equipment Planner