The Joint Commission (“JC”) has expanded the list of health care workers who may and the conditions under which they can employ physical restraints and seclusion when treating patients. JC has revised standard PC.12.90, which addresses the requirement for in-person evaluation of a patient when restraint or seclusion is initiated. Effective immediately, the Standard has been revised to align with the Centers for Medicare & Medicaid Services’ (“CMS”) Final Rule for Patient Rights (the “Final Rule”).
On February 06, 2007, CMS’ Final Rule became a condition of participation requirement that hospitals must meet in order to participate in the Medicare and Medicaid programs (see 42 CFR § 482.13(e)-(f)). The Final Rule applies to all participating hospitals including short-term, psychiatric, rehabilitation, longterm, children’s and alcohol/drug treatment facilities. Now, effective immediately, JC has also adopted the Final Rule as a condition for accreditation.
The Final Rule (and now standard PC.12.90) requires that a patient be evaluated “face-to-face” within an hour of a patient being restrained or secluded for the management of violent or self-destructive behavior. These actions have to be reviewed within that hour by a physician, other licensed independent practitioner (“LIP”), a trained registered nurse (“RN”) or physician assistant (“PA”). When an RN or PA performs the 1- hour-rule evaluation, the physician or other LIP treating that patient must be consulted as soon as possible. The Final Rule also requires that restrained patients must be continually observed. It is available at: http://a257.g.akamaitech.net/7/257/2422/13nov20061500/edocket.access.gpo.gov/cfr_2006/octqtr/pdf/42cfr482.13.pdf. Patient restraint devices can be dangerous, even when used properly, and can cause serious injuries including death. To minimize the liability risk that the use of restraints may pose to hospitals, hospitals should consider the following:
- alternatives to restraints should be used whenever possible;
- patients should be frequently observed in restraints;
- restraints should be adjusted for patients’ comfort;
- those using restraints should always follow manufacturers’ directions for use;
- patients’ medical records should be well documented with the basis for, the conditions under which and the duration of the use of restraints; and
- hospitals should have and strictly follow a written policy that states when and how restraints can and cannot be used.