Many of the changes to Chapter 2.5 for the design of Psychiatric Facilities are benign.There are a few subtle wording changes that do affect the meaning of the sections of the Guidelines they alter, and there are a few proposed revisions that will affect the construction and operating costs of new facilities.
The most prominent change in the 2014 guideline that applies to Behavioral Health is the introduction of section 2.5 – 3.5 on Electroconvulsive Therapy Facilities (ECT). This requirement is the first time ECT appears in the Guidelines and for the first time helps define the program and area requirements for ECT treatment and recovery. Many of the requirements included in this section are just good practice.
Below is a brief synopsis of some of the changes and how they may affect future design:
Section 2.5 – 220.127.116.11 makes the security measures the responsibility of the owner and should be described in the functional program required by the authorities having jurisdiction.
Section 2.5 – 18.104.22.168 changes perimeter security from a requirement to a facility decision. Paragraph number two changes the word “prevent” to “limit” when talking about design for prevention of smuggling contraband into the facility.
Section 2.5 – 2.2.1 requires the primary access point of a locked unit be through a “sallyport.” This requirement could have many possible design and cost implications to a new or remodeled facility. The definition of “sallyport” should be further refined in the Guidelines. Sallyport could mean a large vestibule with interlocking doors or it could just be two sets of doors in series that create a vestibule. Both cause space concerns and concerns for handicapped access.
Section 2.5 – 22.214.171.124 defines criteria for operable windows, if they are provided. Openings are limited to a 4” sphere. This section also adds the requirement that window treatments are designed without accessible anchor points to prevent potential ligature points.
Section 2.5 – 126.96.36.199 states that the patient privacy requirements for acute care hospitals do not apply to psychiatric patient rooms.
Section 2.5 – 188.8.131.52 regarding patient toilet rooms adds the words, “if a swinging door is used,” when talking about patient toilet room doors. This phrase allows for the omission of the door on the toilet room. This change will strengthen the position for omitting the door in states which currently require a solid door on the patient toilet room.
Section 2.5 – 2.2.3 adds many requirements for outdoor areas in psychiatric facilities; all of which are common sense, except for the added requirement that trees and bushes not be placed adjacent to the fence or wall. This point should be clarified. Trees that grow high enough to aid in elopement obviously should not be placed next to fences or walls, but bushes should be a size that prevents a person from hiding regardless of where it is placed in the outdoor area.
Section 2.5 – 184.108.40.206 quiet rooms will no longer be a requirement, but this section does provide guidelines if a quiet room is required by the facility’s functional program.
Section 2.5 – 220.127.116.11 is a new section. This section recognizes the use of comfort/quiet rooms in psychiatric care. It allows for the number of seclusion rooms to be reduced (to not less than one) if comfort/quiet rooms are provided in short-term facilities. In long-term facilities, comfortable quiet rooms are permitted to replace seclusion rooms.
Section 2.5 – 2.2.5 alters locations of support areas for patient care and requires that these areas be located on the unit or adjacent and not just “available.” In particular, equipment and supplies storage must be on the unit.
Section 2.5 – 18.104.22.168 changes the requirements for medication dispensing areas in an effort to create quieter, distraction-free zones to reduce medication errors. Noise reduction from adjacent spaces and improved lighting requirements are among the new guidelines for these “Medication Safety Zones.”
Section 2.5 – 22.214.171.124 revises the requirements for emergency equipment storage to do the same as an acute care hospital. The section of that is referenced as “stricken through.” This will require further explanation by FGI.
Section 2.5 – 126.96.36.199 requires an Environmental Services Room to be on the unit.
Section 2.5-188.8.131.52 requires staff storage for personal belongings to be on, or immediately accessible to the unit.
Section 2.5 – 184.108.40.206 allows the provision of an access point to the patient toilet rooms directly from the corridor as well as from the patient room.
Section 2.5 – 2.4.1 changes the terminology “Geriatric” to “Alzheimer's and Other Dementia Unit,” whereas later in the sub-paragraphs, “Geriatric, Alzheimer's and Other Dementia Units” are referenced. Further clarification is required to explain this change.
Section 2.5 – 220.127.116.11 changes some of the requirements for nurse call in geriatric units and all psychiatric nursing units, removing some of the more stringent requirements.
Section 2.5 – 3.1 removes the word “treatment” from the previous title, “Examination and Treatment.”
Section 2.5 – 3.3 deletes “nuclear medicine” from the chapter on psychiatric facilities.
Section 2.5 – 3.4 rehabilitation therapy services refer back to the sections on Rehabilitation Therapy in General Hospitals. It necessitates that programs in Psychiatric Facilities adhere to space requirements for programs and provide the support spaces required in General Hospitals for all types of therapy.
We highly recommend to our clients that are involved in the design, construction and ongoing maintenance of facilities to go online and read and comment on the sections that they are not comfortable with or don’t agree with. You can download the 2014 draft at www.fgiguidelines.org and can register and submit suggested changes via the same website.