Ligature Point and Other Self-Harm Risk Assessment Experience Survey

1. Are you currently working for, or seeing patients in, a facility that participates in Medicare and is subject to the Centers for Medicare and Medicaid Services (CMS) Hospital Conditions of Participation (CoP)?

• Yes
• No

3. Please select the option that best describes the facility subject to the onsite survey.

• Acute inpatient psychiatric unit located within a general/medical hospital.
• Acute inpatient unit that is part of a stand-alone psychiatric hospital.
• Another type of unit and/or facility (e.g., general/medical hospitals with scatter beds). Please Specify (Required) Please enter an 'other' value for this selection.

4. As part of your work caring for patients within this facility, have you had any involvement in the performance of, or preparations for, the Joint Commission (TJC) onsite surveys?

• Yes. I am the lead administrator responsible for participating in the survey process and responsible for overseeing modifications detailed in the plan of correction.
• Yes. I share some responsibility for participating in the survey process. However, I am not responsible for overseeing modifications detailed in the plan of correction.
• No. I do not participate in any portion of the survey process.

6. Prior to the onsite survey did you receive any communication from TJC regarding any changes to the survey process?

• Yes
• No

8. Has your facility received citations associated with perceived ligature point or other self-harm risks? If yes, please select all options that apply.

• Yes. Ligature point risk.
• Yes. Other self-harm risk.
• No.
• I don't know.

9. If you responded yes to the previous question (Q7), please describe if the citations were: 

• Localized to a particular unit
• Found throughout the facility or healthcare system.

10. Did that citation result in your facility having to be resurveyed after modifications were made?

• Yes
• No

12. Have patients treated in your facility experienced negative consequences resulting from the environmental modifications undertaken in a response to the ligature risk related citations generated by the recent survey (e.g., reduction in personal dignity, loss of privacy)?

• Yes
• No
• I don't know.

13. Of the areas cited and included in the facility’s plan of correction, did you disagree that the findings cited as ligature risks pose a risk to patient safety?

• Yes
• No
• I am not aware of what was in the plan of correction.

14. Are you aware of any completed hangings or attempted hangings in your facility?

• No
• Yes. Please provide details, including approximate dates. (Required) Please enter an 'other' value for this selection.

15. Due to the citation(s), please list any actions your facility has, or is planning to take, that could impact the delivery and/or availability of psychiatric services at your facility, due to the financial burden associated with implementing the modifications in the remediation plan.

• Closing psychiatric inpatient units;
• Decreasing number of psychiatric inpatient beds;
• Reductions in other psychiatric services; or
• Reductions in workforce.
• Others Please enter an 'other' value for this selection.

16. As a result of the citation, is the facility or healthcare system in jeopardy of losing Joint Commission accreditation?

• Yes, the facility or healthcare system is at risk of losing TJC accreditation.
• No, the most recent TJC survey does not jeopardize the facility or healthcare system’s TJC accreditation.
• I do not know.