Hospitals have a duty to not only provide the best-possible care for their patients, but also to ensure their safety at all times.
When considering the safety of young and vulnerable patients in particular, hospital estate and facilities teams must have a robust strategy in place to prevent accidents.
A significant part of this is putting appropriate safety measures in place for all hospital windows. And, following a Department of Health Estates and Facilities Alert in November 2014 about the dangers of window restrictors of cable-and-socket design, there is undoubtedly more focus on this issue than ever before.
When considering the safety of young and vulnerable patients in particular, hospital estate and facilities teams must have a robust strategy in place to prevent accidents
This warning was issued following a fatal incident involving a resident who fell from the second-floor window of a mental health crisis house. The subsequent inquest identified problems with the type of window restrictor fitted.
The DH alert reported that certain window restrictor mechanisms, when locked, can be opened with commonly-available flat-bladed instruments as well as the key provided.
The restrictor in question was of a widely-available design, where a cable mounted in the opening frame clips into a socket mounted to a non-opening part of the frame, restricted to a maximum of 100mm.
Evidence at the inquest demonstrated that if the cable was clipped into the socket by a simple push it would appear secure when pulled or tugged. However, just by pushing the key lock/release button the cable was released.
In addition, the cable was only found to be secure when physically locked with a key and, even if locked, the lock was easily defeated within no more than a couple of seconds by inserting a blade or a pair of scissors into it.
Safety conscious
The report also identified other types of restrictor deemed inappropriate for the protection of vulnerable people, such as those in mental health and dementia care units. These include models which restrict opening when a window is initially unlocked, but which can be overridden by pressing a button or disengaging to allow fuller opening; and others that have been found to defect under certain forces.
As a result, the Health and Safety Executive (HSE) has ruled that, while such restrictors may comply with current British Standards, they are unlikely to be suitable for the health and social care market where the vulnerable are at risk of falling.
It has, however, advised that alternative designs of cable and socket type restrictors, which are not easily defeated, would be suitable for these premises.
The Health and Safety Executive has ruled that, while such restrictors may comply with current British Standards, they are unlikely to be suitable for the health and social care market, where the vulnerable are at risk of falling
So, what does this mean for the future of window safety in hospitals?
While the HSE continues to liaise with the BSI, setting out its concerns and the need for improved standards for different types of restrictors, responsibility to assess the risk of falls from windows and to select and fit suitably-robust restrictors remains with hospital estates and facilities teams.
Indeed, it has been advised that all healthcare organisations should have now reviewed their existing risk assessments and inspection and maintenance systems relating to window restrictors.
As a critical part of this, all window restrictors should have been inspected to ensure they meet the guidance cited in HBN 00-10 Part D, are suitably robust, are in good working order, and have not been damaged, disconnected or defeated, and are not capable of being so. Should any problems have been identified, estates and facilities managers should have initiated a high-priority programme to replace damaged or unsuitable restrictors with a more-suitable design.
Giving freedom
Jackloc’s window restrictors are currently helping to enhance safety across a network of care homes in Leicestershire run by Freedom Care.
The units provide bespoke care for adults suffering from communication difficulties, Asperger’s Syndrome, autism, ADHD, and personality disorders as well as other complex conditions.
It has been advised that all healthcare organisations should have now reviewed their existing risk assessments and inspection and maintenance systems relating to window restrictors
Freedom Care founder, Joseph Kinch, said: “Keeping our residents safe is a key priority, but this has to be addressed in a way that does not inappropriately restrict their freedom.”
Indeed, to lock a window or door, any care home must obtain permission from the local authority Deprivation of Liberty Safeguards (DoLS) department.
The Jackloc was approved as it restricts the window opening to a safe distance, but still allows sufficient ventilation.
Kinch said: “Residents who have tried to escape in the past feel calmer and safer just knowing that climbing out of the window is no longer an option.”
