Nurse Call System

Q: My facility is upgrading from a hard-wired to a wireless nurse call system. Our safety and supply manager is concerned that call systems have to have a form of 2-way communication such that the nursing desk is able to speak to residents while in their room. Is this accurate?

A: The 2014 FGI Guidelines, section 2.1-8.3.7.2 does say each patient sleeping bed shall be provided with a patient call station equipped for two-way communication.

So, it appears your Safety/Supply person is correct.

Length of Emergency Pull Cord

Q: Can you reference the standard, code or any information from Joint Commission, CMS or any other regulatory organization on the length of the emergency pull cord in a patient used bathroom? Thanks

A: No… The end of the nurse call cords located 4-inches above the floor is an interpretation, not a standard. It is based on the FGI Guidelines, 2014 edition, section 2.1-8.3.7.3 which says a nurse call station shall be activated by a patient lying on the floor in each room containing a patient toilet. Accreditation organizations have used the so-called “4-inch rule” as an interpretation of the FGI Guidelines section 2.1-8.3.7.3.

Since there is no specific standard that identifies the maximum or minimum distance that the end of the call-cord can be from the floor, you can set your own policy, provided it is documented and approved by your respective committees. If your own policy said 6-inches would comply with FGI Guidelines 2.1-8.3.7.3, then the surveyors would have to accept that, since their agencies have not specified the distance between the floor and the end of the cord. But if you don’t have a policy on the distance between the floor and the end of the cord, then the surveyors will assess you based on their own interpretation, which for the most part, is 4-inches. However, if your policy said something that was entirely unreasonable, then the surveyors have the right to find you non-compliant.

I suggest you have a policy that identifies an acceptable range, say 3-inches to 6-inches, to allow a little fluctuation in the field. Get your respective Safety committee and Infection Control committee to approve that policy and then the surveyors cannot cite you for non-compliance unless you’re non-compliant with your own policy.

Cords on Nurse Call Stations

Q: We have a behavioral health unit and want to know if pull-cords are required on the nurse-call system in the patient bathroom? Is there an alternative to cords so this type patient can’t hang themselves?

A: The NFPA codes and standards do not address this issue, but the FGI Guidelines do. CMS and the accreditation organizations expect you to follow the FGI Guidelines for new construction, unless there are other more restrictive requirements for other authorities, such as state health departments or local building codes.

Section 2.5-8.3.7.2 of the 2010 FGI Guideline says a nurse call system is not required in psychiatric nursing units, so you do not have to provide cords on the call-buttons. Also, section 2.5-2.4.9.2 says call cords or strings in excess of 6 inches are not permitted. Now, the latter section is for geriatric, Alzheimer’s, or dementia units, but the concept can carry-over to your behavioral health unit.

Nurse Call Station Pull Cords

Q: Are pull cords required on nurse call stations in outpatient facilities (physical therapy, outpatient surgery centers, etc?

A: Based on the FGI Guidelines, nurse call stations in hospital bathrooms, shower rooms and toilets for inpatients must be able to be activated by a patient lying on the floor. In those situations you would be required to have a cord on the nurse call station that is able to reach to the floor. But many Infection Control specialists will want the end of the cord to be about 4 inches above the floor so the cord does not become contaminated with a mop when the bathroom floor is cleaned. However, according to the FGI Guidelines, a nurse call station is optional in outpatient locations; not mandatory. So, if you had them in the outpatient locations, there would not be a requirement to have cords on them. Please check with your state or local authorities to determine if they have more restrictive requirements.

Nurse Call System

Q: Could you please tell me or point me to the requirements for nurse call systems in a hospital? I am particularly interested in the application requirements for nurse call system “zone lights”, and the auxiliary rooms where audible and visible annunciation is required. I have reviewed our local DHEC regulations in South Carolina, but they are not as clear as I had hoped…

A: I would recommend the 2014 Facility Guidelines Institute (FGI) Guidelines for Design and Construction of Health Care Facilities. They have quite a bit to say about nurse call systems.

Wireless Nurse Call System

Q: We are looking at the difference between a “wired” and “wireless” nurse call system in our healthcare facility addition. Our current health center has a “wired” call system however our I.T. department wants us to go with a “wireless” system. I could see where it will only take one bad incident with a wireless system and the authorities will say that everyone must have a wired system or have one as a back-up. What is your thought on this subject?

A: My experience with the national accreditation organizations is they are all for new technology. While none of them have standards or interpretations that directly address the use of wireless technology (that I am aware of), I believe they would be in favor of it. However, if there is a perceived risk in using wireless technology then that risk must be assessed through a risk assessment and appropriate mitigation activities implemented. The bottom line is this: You get to decide the level of mitigation activities for a wireless nurse call system. If you decide having a hard-wired system in place as a back-up system is appropriate, then that is what you do. Other possibilities include a manual bell system, or post additional aids or runners in the corridors listening for a call until the wireless system is up and running again.