Understanding Ligature Risk Management and Its Impact on Patient Safety.

Ligature risk management is an important part of patient safety, especially in healthcare settings like mental health facilities.

It’s about finding and reducing the risks related to ligature points, places where people could use something to hurt themselves.

The article will help you understand the risks of ligature. We will look at the statistics, provide a checklist for ligature assessment, and discuss staff training to help minimise risks and support both the team and patients at risk.

Key Findings on Ligature Risk from Research

Research in mental health settings [Nulfied Trust, PubMed, and JTC] shows that 77% of suicides on psychiatric wards happen by hanging. However, the number of hanging cases has dropped by 74% since 1999.

Common ligature points, or places where people might try to harm themselves, include doors, hooks, handles, and windows. The most used items for this are belts, sheets, towels, and shoelaces. Over time, the use of shoelaces, doors, and windows for self-harm has increased.

In England, the number of suicides by people in contact with mental health services went up by 15%, from 1,124 in 2006 to 1,297 in 2021.

In 2021, there were 230 suicides in Scotland and 70 in Wales among people who had been in touch with mental health services in the past year.

The risks can be different for men and women. 55% of male suicides and 42% of female suicides in mental health facilities are by hanging. In England, the rate of suicide among men using mental health services dropped by 59% from 2006 to 2021, while the rate for women dropped by 54% in the same time period.

While both genders often use hanging, there might be small differences in the types of items used, but this isn’t fully clear in the research.

What is Ligature Risk Management?

Ligature risk management is a methodical way of finding, assessing, and reducing the risks of self-harm in places where vulnerable people are. It involves checking the environment to remove or reduce objects and fixtures that could be used for suicide or self-injury.

The process includes regular safety checks, staff training, changes to the environment to make it safer, and putting rules in place to lower the risk of ligature points.

Risk management also includes ongoing monitoring, assessing each person’s individual risk, and creating personalised safety plans for those at high risk.

Here are the key parts of effective ligature risk management:

Risk Assessment and Identification:

• Regularly check for possible risks, at least once a year.
• Look at past incidents to understand risks in your area.
• Involve different teams in spotting and assessing dangers.

Environmental Considerations:

• Design spaces like bedrooms and bathrooms so patients have fewer chances to harm themselves when not being watched.
• Use special fittings, like anti-ligature window locks, taps, and coat hooks.
• Consider using ligature monitoring systems to alert staff if someone tries to harm themselves.

Staff Training and Awareness:

• Provide all staff with proper training on ligature risks and safety, based on their roles.
• Make sure staff follow the training and maintain high standards.
• Teach staff how to talk to patients about self-harm or suicide, especially during extra supervision.

Continuous Improvement:

• Have a system in place for managing ligature risks, with regular checks and updates.
• Get feedback from staff to improve how you handle ligature risks.
• Keep updating risk assessments as the environment, patient needs, or incidents change.

Policy and Procedure:

• Create clear policies based on risks, laws, and guidelines.
• Make a plan to reduce risks, considering the environment, patient needs, and staff skills.
• Have rules for handling situations where staff don’t follow the training.

By following these steps, healthcare facilities can create safer spaces, reduce the number of ligature incidents, and show their commitment to protecting patients.

Comprehensive ligature management system checklist

A good ligature management system includes important steps to keep patients safe and reduce the risk of self-harm. These steps are:

Risk Assessment and Identification

• Check for ligature risks at least once a year.
• Look at past problems to find where risks might be.
• Work with different experts to find and check dangers.

Environmental Considerations

• Design areas where patients may not always be watched to stop chances of self-harm.
• Use special fittings, like safe door handles, taps, and coat hooks, that can’t be used for ligatures.
• Use tools like the SENTRY Complete Door System to alert staff if someone is at risk.

Staff Training and Awareness

• Teach all staff about ligature risks and what to do, based on their job.
• Make sure all staff follow the training and do it well.
• Train staff on how to talk to patients about self-harm or suicide.

Policy and Procedure Development

• Create clear rules and steps based on risks and laws.
• Make a plan to reduce risks, thinking about the building, the patients, and the staff.
• Set rules for staff who don’t follow training.

Continuous Improvement

• Have a system to check ligature risks all the time.
• Ask staff for feedback to help spot and manage risks.
• Update risk checks when things change.

Emergency Response Preparedness

• Make sure ligature cutters are ready and well-kept.
• Do practice drills to make sure staff know how to act in an emergency.

Documentation and Reporting

• Keep clear records of checks, problems, and actions taken.
• Set up a system to report risks and near-misses.

By doing all these steps, healthcare facilities can keep patients safer and reduce self-harm risks.

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How do you conduct a comprehensive ligature risk assessment?

A complete ligature risk assessment includes several important steps:

1. Gather a Team: Bring together mental health professionals, staff, and safety experts to carry out the assessment.
2. Review Past Issues: Look at previous incidents and audits to understand past risks.
3. Use a Trusted Tool: Use a reliable tool to find possible ligature points in each room and area. This tool should consider the type of service and patient group, and apply a risk rating system.
4. Check Patient Areas: Inspect all areas where patients can go, including courtyards. Areas where staff are always watching patients can be excluded.
5. Identify Ligature Points: Look for places like fixtures, fittings, and building features that could be used for self-harm.
6. Evaluate the Environment: Check for anti-ligature fixtures, such as special window and door locks, taps, and showerheads.
7. Consider Patient Risk: Take into account the risks posed by the specific group of patients in the facility.
8. Make Staff Aware: Make sure staff know how to handle ligature risks properly.
9. Document the Risks: Write down the identified risks, rate their severity, and suggest actions to fix them.
10. Create a Risk Plan: Develop a plan to address risks related to the environment, staff, and patients.
11. Submit the Report: Share the completed report with the clinical lead and governance team.
12. Monitor Progress: Set up a system to check how well the risk management plan is working and deal with new challenges.
13. Reassess Regularly: Perform regular checks, at least once a year, or when major changes happen in the facility or patient group.

By following these steps, healthcare facilities can conduct thorough ligature risk assessments and create plans to reduce risks effectively.

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What specific training is required for staff involved in ligature risk assessments?

Staff involved in ligature risk assessments need full training to spot and handle potential risks. The training includes:

• Ligature awareness training: Understanding what ligatures are, the history behind them, and trends in self-harm and suicide.
• Ligature risk assessment training:
  • How to assess risks for ligatures
  • How to identify potential ligature points and materials
  • Using approved templates to assess ligature risks
• Environmental risk assessment training:
  • How often to check for risks
  • Finding possible ligature points and materials in the environment
  • Using anti-ligature devices and other safety measures
• Using and maintaining ligature cutters safely.
• Safe removal techniques for people who are hanging or suspended, including proper handling.
• Post-incident procedures: Providing first aid, CPR, preserving the scene, and reporting the incident.
• Therapeutic engagement skills: Talking to patients about self-harm or suicide during special observation periods.
• Understanding of legal rules: Learning about the mental health act, confidentiality, consent, and data protection.
• Training to spot changing suicide risks and ligature hazards in clinical settings.
• Checking fixtures and fittings for wear and tear to reduce ligature risks.
• Simulations and drills: Practicing responses to ligature incidents to ensure staff are ready.

This complete training ensures staff can safely assess ligature risks and respond quickly in emergencies.

Training Available:

Training your staff on ligature awareness, first aid, mental health support, and risk management makes the workplace safer. It helps your team spot dangers, act fast in emergencies, and support people who need help.

The following recommended training helps prevent harm and improve care:

• Ligature Training
• Emergency First Aid Training at Work
• Basic Life Support Training
• AED and CPR Training
• Risk Assessment Training
• Self Harm Online Training
• 2 Days Mental Health First Aid Course