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Respect for individual rights - locked doors

 

Why we looked to see if doors were locked

Locking doors in hospitals to stop people from leaving is a form of restraint. Any restriction on the freedom of movement of a person by others should only be considered when an individual is considered to be at risk.

We wanted to know that if an individual's personal freedom was being limited that this was being done in a legal, compassionate and ethical manner.

What we would expect to find

There may be occasions when for reasons of personal safety and security that it is necessary for the main exit door to be locked.

When we come across a locked exit door we expect to be given a reasonable explanation for it. We also expect that a local policy, regularly reviewed, is in place and that any restrictions are being carried out in an ethical manner that respects the rights of all the people on that ward.

What we found

Of the 62 wards that we visited, the majority had a locked front door.

Some hospitals had taken a decision, for security reasons, to have the main entrance door locked, usually to control who entered the ward but people inside the ward could still exit freely.

Community and cottage hospitals that we visited were more likely than other hospital wards to have a locked door.

Wards for people with dementia were twice as likely to be locked as those for people with functional illness alone.

Ward type (functional, dementia or both) by whether main door usually locked

 

 Door locked

 Door unlocked

 Total

 Functional mental illness ward

 7(44%)

  9(56%)  16 (100%)
 Dementia ward  27(82%)  6(18%)  33(100%)
 Both functional and dementia  11(85%)  2(15%)  13(100%)

 Total

  45(73%)  17(27%)  62(100%)

On the wards where the main exit door was locked, we asked the nurse in charge to tell us about the door locking policy. We wanted to hear about the reasons for the door being locked, who had been consulted prior to this decision being taken and how often the decision was reviewed.

In only half of these wards did we receive a satisfactory response.

Some wards told us that there was a door locking policy in place but when we explored this further we were told that the policy simply was a practice that the door was permanently locked. We did not accept this as a satisfactory response.

We visited a functional assessment ward that we had visited many times previously. This ward always had the front door open except on rare occasions when the local policy had been put in place. At this visit the front door was locked. We asked why this was and were told the new charge nurse had taken the decision to permanently lock the door. This had not been discussed with anyone else and had quickly become an accepted practice. We asked that the managers urgently review this practice.

We visited a ward that admitted some older people but was an adult acute psychiatric admission ward in a large general hospital. The design of the ward was not sympathetic to the needs of some of the older people admitted there. The main exit door opened automatically as you approached it and staff told us this was problematic as often people were not looking to leave but did so when the door opened as they approached.

Good practice

At St John's hospital the mixed functional and dementia assessment ward has introduced a swipe card system for the main exit door. Following a risk assessment, anyone who can use these cards is given one so they can freely exit the ward.

Action needed

  • All assessment wards for older people must, if the door is either permanently or temporarily locked, have a policy in place for locking the door. This policy should state the reason for this and set out a clear monitoring and review process. It must also address the rights of people who are not detained under mental health legislation.
  • People who want to leave the ward and who are able to do so should not have unnecessary barriers put in their way.
  • The use of technology can help minimise the limits on a person's personal freedom and its use should be considered.