Fire Extinguishers in Psychiatric Units
Q: We recently had a situation at our psychiatric hospital. A patient was able to open a fire extinguisher box, which are all keyed, and he discharged the fire extinguisher in the unit. The fire alarm went off (powder all over); he then broke the window of his room and eloped. My questions are:
Is there a standard that requires those fire extinguisher boxes to be breakable if we don’t have the key?
Will the Life Safety Code allow us to have the fire extinguishers in the nursing station and not in the hallways where patients have access?
A: First of all, what you have described is an Immediate Jeopardy situation, and one that CMS or your accreditation organization can use to cite you with an IJ. While it is not a requirement that you self-report this event to CMS or your AO, they will learn about this event through social media and normal communications with the organization. Be prepared for a surprise survey based on this event.
CMS and the AOs are really strict on potentially harmful situations (like ligature points) in behavioral health units, and what you have described is definitely a problem. Here is what NFPA 10-2010 says regarding the placement of fire extinguishers:
6.1.3 Placement.
6.1.3.1 Fire extinguishers shall be conspicuously located where they are readily accessible and immediately available in the event of fire.
6.1.3.2 Fire extinguishers shall be located along normal paths of travel, including exits from areas.
6.1.3.3 Visual Obstructions.
6.1.3.3.1 Fire extinguishers shall not be obstructed or obscured from view.
6.1.3.3.2 In large rooms and in certain locations where visual obstructions cannot be completely avoided, means shall be provided to indicate the extinguisher location.
A.6.1.3.3.2 Acceptable means of identifying the fire extinguisher locations include arrows, lights, signs, or coding of the wall or column.
You say the extinguishers were in a cabinet and locked, so I presume the staff had keys to access the extinguishers. That plan proved to be a problem, so I would suggest you remove the extinguishers from the cabinets and place them in staff areas only, such as a nurse station, utility room, etc. If the extinguishers end up being placed in areas where they cannot be readily accessible, then place signs on the wall (can be signs painted on the wall) indicating their location. Also, you would remove the cabinets from the walls and patch the walls.
I would conduct a risk assessment (quickly), identifying the risks to patient and staff of the extinguishers in the wall-cabinets and conclude that placing them in restricted areas is the sound decision. Then have your Safety Committee review and approve the risk assessment and then write a policy regarding the new locations of the extinguisher so it is well documented. If any surveyor questions the locations of the extinguishers, you then show them your risk assessment and new policy (and the minutes from the Safety Committee) proving that you had a serious situation and it has been mitigated by the relocation of the extinguishers.
You are very fortunate that the patient did not harm others or himself with the extinguisher. I would act quickly as you really can expect a surprise survey from CMS or your AO. You want to be able to demonstrate to them that you took quick and decisive action.
