Doors in Healthcare A Healthcare Facility Manager’s Perspective
Overview What is unique to Healthcare Accreditation – What’s the big deal? Healthcare Codes and Standards Doors and Defending in Place Do we have problems - what does the data say?
Why is Healthcare Unique? Different Customers Different Staff Different Facility Different Rules “Patients” Required
Different Customer Sick people Elderly and/or frail Respiratory problems Diagnostic tests Scared/confused
Typical Health Care Staff Single Largest Employer Clinical Staff • First Do No Harm • Licensed & Privileged
Support Staff Focus on Care Here for Different Reason Patient Care is Priority 1
Hierarchy of Hospital Staff Clinical Staff vs. Support Staff •Care Takers of the Care Takers •Making $’s vs. Costing $’s
Hierarchy of Facility Staff Dependent on Facility Size • VA Phoenix • GIMC • UAMS
Who uses it vs. Who buys it Support Staff Focus on Care
Different Facility Built Different - Used Different Technology Advances Lots of needs and desires Aging Buildings and Infrastructure No matter what happens, patient care must go on
Hospital Operational Rules Heavily Regulated Risk Management Oriented Performance/Process Improvement Oriented Clinical Staff Integral Part Patient Care is driving force
Patients = Patience Patients are #1! Keeping them safe & secure The healing environment Image Increasing the value
Accreditation
What’s the big deal?
Accreditation What is accreditation? To give official authorization to or approval of
What are the primary reasons healthcare organizations want to be recognized for conforming with set standards?
Accreditation Recognition of: • Quality patient care services • Commitment to patient safety • Continued improvement
Being accredited sets the stage for how patient care is delivered in all healthcare environments
Accreditation Medicare and Medicaid reimbursement as provided by the Centers for Medicare and Medicaid Services (CMS) • Without accreditation healthcare organizations cannot receive federal reimbursements for services
Who is CMS? Centers for Medicare & Medicaid Services • Previously - Health Care Financing Administration • Federal agency within DHHS
Establishes • Regulations • Reimbursement Rates
Responsible for: • Medicare, Medicaid & CHIP (Formerly SCHIP) • HIPAA • Quality Standards thru Accreditation
Healthcare Codes and Standards
Doors and Defending in Place
History of Various Healthcare Codes/Standards 101 Life Safety Code (NFPA) 1913
2000 Ed
2012 Ed
2003
2016
National Building Code (BOCA) International Code (ICC)
Uniform Building Code (ICBO)
Standard Building Code (SBCCI) 1997
1915 PHS Guidelines
AIA Guidelines
1947
FGI Guidelines 2001
1984 ASHRAE Std 62 1973
Std 170 2008
Included in FGI 2010
2012 Ed NFPA 99
Physical features of life safety Building construction type Compartments Alarms Suppression Compensating for known deficiencies
Compartments The room and corridor Smoke compartments The floor/ceiling assembly Building structure Exits
S&C 17-38 LSC Centers for Medicare & Medicaid Services • Issued clarification on 28 July 2017 • Application of NFPA 80 & 105
Clarifies • Fire Door Assemblies to be Inspected/Tested per 2010 NFPA 80 • In Healthcare Occupancies Non-rated Door Assemblies not required to be tested per NFPA 80 & 105 • Should be routinely inspected as part of the facility maintenance program • Inspection/Testing to be completed by 1 January 2018 • Deficiencies to be cited under K211 – Means of Egress - General
Are there problems?
What does the data say?
LS.02.01.10 – General Requirements Standard Building and fire protection features are designed and maintained to minimize the effects of fire, smoke, and heat. Apr/May 2016
EP’s Evaluated
Top Findings
(10% or greater of findings within the Standard)
(Based on 2,354 findings)
EP 4 - Openings in 2-hour fire-rated walls are fire rated for 1 1/2 hours.
Fire Doors 1,203 findings (51%) (EP’s 4 & 5)
EP 5 - Doors required to be fire rated have functioning hardware, including positive latching devices and selfclosing or automatic-closing devices. Gaps between meeting edges of door pairs are no more than 1/8 inch wide, and undercuts are no larger than 3/4 inch. EP 9 - The space around pipes, conduits, bus ducts, Penetrations cables, wires, air ducts, or pneumatic tubes that penetrate 1,041 findings (44%) fire-rated walls and floors are protected with an approved (EP’s 4 & 9) fire-rated material.
Fire Doors
1,203 Findings
Latch Failure
431
Rating/Label Missing
205
Gap/Undercut
Latch Failure 36%
117
Closer
85
Hardware
71
Lower Latch
Rating/Label MissingPainted 21%
64
Painted Label
47
Holes
45
Jerry-rigged
38
Screw Penetration
34
Damaged
33
Blocked
Gap/Undercut 10%
23
Wedge
10 0
50
100
150
200
250
300
350
400
450
Locking Mechanisms 452 findings
75
Sliding Door Deadbolt
66
Access Control
Access Control 43%
60
Motion Sensor
49 47 46
Exit Button Signage Deadbolt
28
Key
18
Infant Security
13 12 12
Two Actions
Deadbolt 27%
Staff Hardware Failure
7
Pad Lock
5 5 4
Two Delayed Egress Not Fully Sprinklered Waiver
2 1 1 1
Stuck Negative Pressure Ice Snow Egress Direction
0
10
20
30
40
50
60
70
80
LS.02.01.30 – LS Building Features Standard The hospital provides and maintains building features to protect individuals from the hazards of fire and smoke.
EP’s Evaluated
Top Findings
(10% or greater of findings within the Standard)
(Based on 2,488 findings)
EP 2 - All hazardous areas are protected by walls and doors in accordance with NFPA 101-2012: 18/19.3.2.1.
Fire Doors
EP 11 - Corridor doors are fitted with positive latching hardware, are arranged to restrict the movement of smoke, and are hinged so that they swing. The gap between meeting edges of door pairs is no wider than 1/8 inch, and undercuts are no larger than 1 inch. Roller latches are not acceptable. EP 18 - Smoke barriers extend from the floor slab to the floor or roof slab above, through any concealed spaces (such as those above suspended ceilings and interstitial spaces), and extend continuously from exterior wall to exterior wall. All penetrations are properly sealed.
Penetrations
1,311 findings (53%) (EP’s 2 & 11) 590 findings (24%) (EP’s 2, 11 & 18)
Suite and Hazardous Areas 425 findings (17%) (EP’s 2 & 11)
Fire/Smoke Door Failures 1,311 Findings Latch Failure
359
Closer Missing
257
Hardware Missing
233
Gap/Undercut
219
Blocked
104
Rating/Label Missing
79
Painted Lable
12
Door Missing
12
Louver
11
Jerry-rigged
11
Roller Latch
8
Lower Latch
6 0
25 50 75 100 125 150 175 200 225 250 275 300 325 350 375
Latch Failure 27% Closure Missing 20% Hardware Missing 18% Gap/Undercut 17%
Door Failure by Location 1,291 Findings Storage
597
Patient Rm/Corridor
209
Suites
Storage Rms 48%
197
Equip
75
OR
56
Office
51
KIT
29
EVS Rm
24
Converted Strg
22
Lab
Patient Room or Corridor 16% Suites 15%
11
Decon Rm
8
Elev Lobby
7 0
100
200
300
400
500
600
Fire/Smoke Door Gap Failures 218 Findings Suites
75
Patient Rm/Corridor
66
OR
27
Storage
Patient Room or Corridor 30%
25
Equip
12
KIT
Suites - 34%
5
Rehab
2
Office
2
Lab
2
EVS Rm
OR’s - 12% Storage - 11%
1 0
10
20
30
40
50
60
70
80
Blocked Fire/Smoke Doors 98 Findings
Storage
52
Patient Rm/Corridor
16
Equip
Storage Rms 53%
6
Office
4
EVS Rm
4
Suites
3
OR
3
Rehab
2
KIT
2
Elev Lobby
2
Decon Rm
2
Lab
1
Hyperbaric
1 0
Patient Room or Corridor 16%
10
20
30
40
50
60
Fire/Smoke Door LS.02.01.10 & 2,514 Findings 02.01.30 Latch Failure
860
Rating/Label
343
Closer Missing
342
Gap/Under Cut
336
Hardware
304
Blocked
137
Damaged
112
Jerry-rigged
49
Door Missing
12
Louver
11
Roller Latch
8 0
100
200
300
400
500
600
700
800
Latch Failure 34% Rating/Label 14% Closer Missing 14% Gap/Under Cut 13% Hardware 12%
Questions? Jonathan Flannery – jflannery@aha.org – (312) 422.3825
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