The ability of patients to barricade doors to prevent or delay staff from entering a room presents very serious hazards in behavioral health facilities. This threat exists any place where a door swings into a patient accessible room and no other provisions are provided that will allow staff to gain entrance to the room in a timely manner. Patients have been known to barricade themselves into rooms to give themselves time to engage in a wide range of unauthorized behaviors. Building codes often will not allow corridor doors to swing into the corridor because that can reduce the effective width of the corridor needed for exiting in an emergency. Recessing the doors into an alcove so that they can swing out of the rooms without restricting exit width results in hiding places for patients that are usually discouraged in behavioral health facilities.
Barricading can be accomplished by stacking furniture or other heavy objects against an in-swinging door or simply holding the door or having other patients help hold the door to keep staff from entering the room. Barricading can also be accidental as in the case of a patient fainting or collapsing in a small room (like a toilet room) in a location that does not allow clearance to open the door. Whatever the case may be, when barricading occurs, staff need to be able to gain access quickly. These concerns apply not only to patient room and patient toilet room doors but the door to any room to which patients will have access. This includes activity rooms, interview rooms, exam rooms and many others.
There are five different approaches to making doors resistant to barricading which will be discussed in this blog.
• Provide a second door that swings out of the room
• Double acting doors (swings both ways)
• Wicket doors (door within a door)
• Unequal pair of double egress doors
• Quick release hinge doors.
Provide a second door that swings out of the room. This door usually does not open into the Corridor, but an adjacent room or other area where the door does not violate other code restrictions. This is the simplest of the options, but is often not possible because of the layout of the unit.
Double acting doors swing in both directions and usually have a stop that can limit the door to only swinging in one direction for normal operation. The stop can be moved out of the way to allow the door to swing out in to the corridor in an emergency. The most common type of double acting door hinge is the center pivot hinge. These are discouraged in behavioral health facilities for two reasons. The top pivot pin is a potential ligature attachment point and there is a large opening at the hinge side of the door when the door is open that patients with self-destructive tendencies have been known to use to smash their hands. The preferred double acting hinge for use in these facilities is the double acting continuous hinge with full height emergency stop. In some cases, the existing doors can be cut down and reused.