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Open and shut case

Managers of hospitals, care homes and other healthcare buildings need to ensure that the design and installation of doors does not put vulnerable people at risk, says Simon Osborne Commercial Leader of Allegion in the UK and Ireland

It would be fair to say that able-bodied people tend not to think twice about opening a door. It’s a simple, natural choice of push or pull and pass through. However, for less able-bodied people, such as the elderly, young, injured or those with disabilities, a door can represent a number of problems. It can be an obstacle approached with trepidation, a cause of anxiety, or a threat to dignity. In rare cases it can be a dangerous physical hazard. In October 2011, a 73-year-old man was trapped in revolving doors at South Tyneside District Hospital. The man fell and fractured his hip, later dying at the hospital.

A door is expected to offer a safe exit for building occupants. For those of sound mind, this is not a problem – they know where they are going and how to return safely. However, for people who are mentally vulnerable, doors leading to the outside world can be dangerous and even life-threatening.

The Alzheimer’s Society predicts that one million people in the UK will be living with dementia by 2025. One of the main side effects of the condition is wandering. A person with dementia may feel the need to walk about for a variety of reasons, whether it is to relieve boredom or stress, respond to anxiety, or simply because they are feeling lost in a new environment. If the person lives or is based near a main road, or has been admitted to an unfamiliar hospital or facility, it is clear that a door becomes vital to that person’s safety.

A NEW PERSPECTIVE
For facilities managers and owners of healthcare-related buildings, it’s important to look through the eyes of vulnerable people to gain a clearer understanding of how they use doors and interact with door furniture. This will help to better serve their needs and protect them from harm.

A common problem is that the force of a door closer is not suited to the nature of the building’s occupants. In hospitals, all sorts of people may not be able to pass through a doorway before the door closes on them. This can prove difficult or dangerous to children, people with injuries or disabilities, elderly people, or those with reduced upper body strength.

To avoid harm, installing the right door closer with the appropriate strength for the weight and size of door is crucial. Not only will the door close at a speed that enables all users to pass through safely, it will also make the door easier to operate, requiring less strength and force from users. Doors should also be tested in different air pressure scenarios, as during the winter doors and windows are likely to be kept shut to lock heat in. This can mean that doors become more difficult to open and require more force.

   

ELECTRONIC MONITORING
One of the key ongoing developments in the door hardware industry is electromechanical convergence, in which mechanical hardware is merged with electronic and digital systems. The major advantage of this is the ability to monitor doors and their usage, keeping an audit trail and activity log for future improvements. Doors can now be controlled and monitored via apps or central control systems, while latchbolt monitors can detect whether a door is fully closed or not.

This kind of monitoring can make a significant difference in a hospital. In 2009 a 53-year-old patient, who was potentially suffering from mental health problems, wandered into an empty outpatients ward through staff doors at Colchester General Hospital. A set of locked doors prevented the patient from making his way back out. Tragically, he died in the night due to chronic obstructive pulmonary disease.

Facilities managers should consider how easy it is for patients and residents to use the doors and door furniture in their building, and how convenient the doors are for staff. For patients struggling to operate doors on their own, it can become a question of dignity if they have to ask for help every time they want to open a door. This in turn can put a strain on staff and productivity if staff are continually required to leave their tasks to open doors for patients.

Modern door hardware is helping to provide a solution. For example, electromagnetic hold-open closers linked to fire alarm systems can keep a door open, but close automatically in the event of a fire. But while electronics can assist, it’s important that an assessment is carried out before installation to ensure the needs of the users are taken fully into account. The Alzheimer’s Society 2016 report, ‘Fix dementia care, hospitals’, revealed that in a poll of over 570 carers, families and friends of people with dementia, 90 per cent said they felt the person with dementia became more confused while in hospital. Poorly designed and installed doors can only add to that sense of confusion.

Attention should also be given to the needs of those with arthritis or similar conditions, who may find it difficult or painful to grip and turn traditional door handles. One obvious way to overcome these challenges is the familiar panic bar.

SECURITY AND ACCESS
Mechanical panic bars are installed to comply with European standards EN 1125 for panic applications or EN 179 for emergency applications to aid exit from a building. However, a traditional panic bar can compromise security and functionality. The door hardware industry has been developing products that are more fit for purpose.

New technology is undoubtedly improving the range of doors and door hardware available for healthcare environments. But with change comes new responsibilities, as well as a need for new skills, understanding and collaboration. In a hospital where there are hundreds of doors with thousands of daily users, but often only a small team of facilities staff, any change needs to be carefully planned. Installation teams should talk to maintenance teams to devise processes ensuring that the hardware continues to function as it should.

REDUCING RISK
Facilities managers also need to assess and plan for changing conditions and potential problems. For example, healthcare facilities often run from different power sources, with backup generators and power supplies. FMs need to have a plan for a power failure, and how to reduce risk to those potentially affected. In 2016, a power cut triggered a fire alarm in a hospital, causing an electromagnetic closer linked to the fire alarm to automatically disengage from the magnetic holding device. The closing speed of the device was not properly set, and an elderly patient in the doorway was caught and injured by the heavy door – contributing to the patient’s death.

Doors that lock automatically are a potential source of alarm and panic to vulnerable patients, particularly those suffering from claustrophobia or anxiety disorders. FMs need to consider this when purchasing locks – particularly with electric locking devices becoming more prevalent. Electric locks will be sold as ‘fail safe’ (when power is cut, lock is unlocked) or ‘fail secure’ (when power is cut, lock is locked).

Many people passing through healthcare buildings year in, year out will not be challenged by the doors. But many will be, by virtue of age, physical disability or mental condition. FMs must ensure they are given the consideration they deserve at a vulnerable stage of their lives.

About Sarah OBeirne

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