The Joint Commission recently clarified some of its recommendations regarding ligature risks in the hospital environment. In the July issue of TJC Perspectives, they published responses to a set of FAQs received from the field. Most of the responses are essentially clarifications of their initial recommendations published in November 2017.

However, one clarification is particularly noteworthy. It relates to the requirements for inpatient detox units. The question of whether these units need to meet the ligature resistant recommendations for inpatient psychiatric units had previously been somewhat unclear. Now, after further review by the Expert Panel and feedback from the field, TJC has determined that these inpatient detox units do not need to meet those requirements.

Specifically, the TJC response was as follows:

What are the requirements for an inpatient substance abuse detox unit?

Organizations providing inpatient substance abuse detox treatment (as the primary focus of treatment) should follow the recommendations applicable to general acute care inpatient settings, given the complexity of physical health care required to care for these patients. These units do not need to meet the same recommendations as psychiatric inpatient units. As with any patient receiving treatment for mental health, screening, assessment, and reassessment are critical when determining the appropriate level of care.

In addition, we recently contacted TJC with these follow-up questions.

If the inpatient detox unit (in either a freestanding psychiatric hospital or a general/acute care setting) is a detox/rehab unit and serves both patients going through detox and those who have completed detox and are in the rehabilitation phase of treatment, is this type of unit also exempt from the ligature resistant recommendations for inpatient psychiatric units?

We consider a primary substance abuse detox unit an inpatient medical unit in terms of the suicide risk recommendations. As long as the unit is serving a primary diagnosis of substance abuse for detox purposes, we would not apply the ligature risk recommendations because we understand the need for the medical equipment associated with treating those individuals, and they are primarily seeking the treatment for a detox episode. This applies to primary substance abuse detox units in both freestanding psychiatric hospitals and general/acute care hospitals.

For a Dual Diagnosis Unit (in either a freestanding psychiatric hospital or a general/acute care setting) treating patients with a primary mental health diagnosis who also have a chemical dependency diagnosis and are either detoxing or have finished detoxing and are in the rehab stage of treatment, would the inpatient psychiatric setting recommendations for ligature risk apply?

Yes, the inpatient psychiatric setting ligature risk recommendations would apply. Because a dual diagnosis patient has a combination of mental health and substance abuse issues (diagnoses) and this unit is a primary mental health unit, the inpatient psychiatric recommendations would be applicable.

This most recent clarification about inpatient detox/rehab units may be welcome news in terms of renovations required. However, the fundamental message about patient safety is the same — namely, the program needs to evaluate its environment and make sure it’s safe for their patients. And if patients show increased suicide risk, additional measures must be taken to keep them safe in that environment or transfer them to a higher level of care.