Restraint and seclusion are critical areas of focus for both CMS and the Joint Commission, and hospitals frequently face citations for non-compliance. Crafting and understanding restraint policies remains one of the most challenging aspects of healthcare today.
Recent changes by CMS have significantly impacted restraint policies, including a revision in terminology from "licensed independent practitioner" (LIP) to "licensed practitioner" (LP). This update allows Physician Assistants (PAs) to issue restraint orders in states where they are classified as dependent practitioners. The implications of these changes will be thoroughly explored.
Restraints represent a major area of deficiencies within the CMS Conditions of Participation (CoP). CMS publishes quarterly updates on deficiencies, providing insights into the most problematic standards in the restraint section.
Additionally, it is essential for any physician or provider issuing restraint orders to be trained in the hospital’s policies. Both CMS and the Joint Commission mandate annual education for hospital staff on restraint and seclusion interpretive guidelines. This session will assist hospitals in meeting these requirements, highlighting the need for ongoing training beyond initial orientation. CMS outlines extensive training requirements across ten pages, emphasizing the importance of continual education.
Webinar Agenda
- Introduction to CoP Manual
- CMS deficiencies and access
- Complaint manual
- CMS changes to restraint and seclusion
- PA may write orders
- Internal log and soft wrist restraints
- Conditions of Participation for CAH
- Learning from Each other
- Seclusion – what it is and is not
- Medical restraints
- Behavioral health restraints
- Violent and self-destructive behavior
- Definition of restraint and seclusion
- Manual holds of patients,
- Leadership responsibilities
- Two soft wrist restraints, internal log and documentation
- Culture of safety
- Drugs used as a restraint
- Standard treatment
- Restraints does not include
- Side rails, forensic restraints, freedom splints, immobilizers
- Assessment
- Need order ASAP
- Order from LIP and notification of attending physician ASAP
- Documentation requirements
- Least restrictive requirements
- Alternatives
- RNs and One-hour face to face assessment
- Training for RN doing one-hour face to face assessment
- New training requirements
- New death reporting requirements
- Ending at earliest time
- Revisions to the plan of care
- Time limited orders
- Renewing orders
- Staff education
- First aid training required
- Monitoring of patient in R/S
- Joint Commission Hospital Restraint standards and differences from CMS
Who Should Attend
- All nurses with direct patient care
- Compliance officer
- Chief nursing officer
- Chief of medical staff
- COO
- Nurse Educator
- ED nurses
- ED physicians
- Medical staff coordinator
- Risk manager
- Patient safety officer
- Senior leadership
- Hospital legal counsel
- Chief Risk Officer
- PI director
- Joint Commission coordinator
- Nurse managers
- Quality director
- Chief medical officer
- Security guards
- Compliance officer
- Accreditation and regulation staff and others responsible for compliance with hospital regulations
- Anyone involved in the restraint or seclusion of patients.
- Persons responsible for rewriting the hospital policies and medical staff bylaws
- Staff that remove and apply them as part of their care such as radiology techs, ultrasound technologists, transport staff, and others.
