New CMS Guidelines: Hospital Restraint and Seclusion in 2023

Join us for an informative webinar on CMS Hospital Restraint and Seclusion guidelines. Restraint and Seclusion practices are under intense scrutiny by both CMS and the Joint Commission, making it a crucial area for hospitals to address compliance issues. In this program, we will focus on the most challenging standards within the restraint section.

Both CMS and the Joint Commission emphasize the significance of staff education regarding restraint and seclusion interpretive guidelines. Annual training is required for hospital staff to ensure they stay up to date with the latest standards and best practices.

Don't miss out on this opportunity to gain valuable insights into CMS Hospital Restraint and Seclusion guidelines. Register now for our webinar and ensure that your hospital stays in full compliance with these critical regulations.

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https://conferencepanel.com/conference/cms-hospital-restraint-and-seclusion

1. RESTRAINT AND SECLUSION
2023
Navigating a Problematic
CMS Standard

2. 2
Speaker
▪Laura A. Dixon, Esq.
▪BS, JD, RN, CPHRM
▪President, Healthcare Risk
Education and Consulting, LLC
▪303-955-8104
▪[email protected]
▪Email questions to CMS:
Critical Access Hospitals: [email protected].
Acute hospitals: [email protected].
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3. Rethinking Restraints in Hospitals
▪Study found 27,000 patients restrained every
▪About 5 per hospital and prevalence is 50 per 1,000
patient days
▪2007 Study in Journal of Nursing Scholarship, Vol 39, Issue 1, Page 30-37, Prevalence and Variation of Physical
Restraint Use in Acute Care Settings in the US
▪Restraints increase the risk for delirium by 4-fold
▪JAMA March 20, 1996:;275(11):852-857, Precipitating Factors for Delirium in Hospitalized Elderly Patients
▪Restraints increase the rates of pressure ulcers,
respiratory complications and even death via
strangulation and aspiration
▪HHS study in 2006 found that 40% of hospitals fail to
report deaths to CMS
▪Hospital Reporting of Deaths Related to R&S, OIG and HHS, at http://oig.hhs.gov/oei/reports/oei-09-04-00350.pdf
3

4. Why RNs Reduce Need for Restraints
▪If low number of registered nurses:
▪Odds of using restraints were 11% and 18% higher
▪Use of restraints to prevent a fall were 9 to 16% higher
▪RNs are better trained to find alternatives to restraint
and seclusion
▪Physical restraints can include belts, mittens, vests (note
most hospitals do not use), bedrails, geriatric chairs, and
other devices
▪It is not the number of staff present to reduce falls
but rather having adequate number of RNs
4

5. 2022 Article: Use of Restraints in Hospitals
▪Study utilized three topic-based focus groups
▪19 participants from nursing, PT and medicine
–Participants noted lack of precise hospital guidelines
–Documentation often lacked the effect of restraint on patient’s
behavior
–Restraints were described as a safety measure
–Implementation most often led by nurses
–Attitudes and experiences were main detriments for restraint use
–Experienced nurses tended to use restraints less
–Prior experience with violence → more use
▪https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8859
077/pdf/NOP2-9-1311.pdf
5

6. Introduction to the CoPs on
Restraint and Seclusion

7. 2019 Changes to R&S*
▪Changed “licensed independent practitioner” to
“licensed practitioner”
▪Allows Physician Assistant to order R&S in state that held
the PA was a dependent practitioner
▪Physician and other licensed practitioner training
requirements must be specified in the hospital policy
7

8. Hospital Deficiency
Data

9. Number of R&S Deficiencies
Tag Number January 2023
154 Use of Restraint or Seclusion273
159 Definition: physical restraint38
160 Definition: chemical restraint78
161 What Is/Is Not a restraint18
162 Definition: seclusion 39
164 Less Restrictive Ineffective118
165 Type Least restrictive 89
166 Written Modification of Plan237
167 Safe & Appropriate Technique197
168 Order Required 677
9

10. R&S Deficiencies
Tag Number January 2023
169 Never a Standing Order 91
170 Attending Consultation 27
171 Time Limits for Restraints 140
172 Assessment in 24 Hours 16
173 Order Renewed by Policy 77
174 D/C R&S Earliest Possible Time170
175 Trained Staff Monitor Patient318
176 Training Requirements in Policy53
178 One-Hour Face-to-Face 172
179 One Hour Evaluation Elements163
10

11. R&S Deficiencies
Tag Number January 2023
180 State Can Be More Restrictive 3
182 RN Consultation with Attending 15
183 Continuous Monitoring for R&S 4
184 Documentation: 1-hour F2F 39
185 Documentation: Behavior and
Intervention Used
54
186 Documentation: Alternatives Used47
187 Documentation: Patient’s Condition37
188 Documentation: Patient’sResponse52
194 Staff Training Required 71
196/199 Training Intervals & Content93/19
11

12. R&S Deficiencies
12
Tag Number January 2023
200 Training: Non-physical Intervention36
201 Training: Least Restrictive Methods8
202 Training: Safe Application R&S 35
204 Training: Identify R&S Can Be D/Cd3
205 Training: PatientMonitoring R&S 22
206 Training: First Aid and CPR 94
207 Training: By Qualified Trainers6
208 Documentation of Training 56
213 Death Reporting –to CMS 25
214 Death Reporting –Internal Log 46 Total 3,759

13. CMS Surveyor Training
Website

14. Complaint Manual

15. CMS Hospital CoPs on
Restraint and Seclusion

16. SECLUSION

17. RESTRAINTS
Standards and Guidelines

18. Not Covered By Rule –Law Enforcement
▪What:
▪Handcuffs
▪Manacles
▪Shackles
▪Other chain-type restraint
devices
▪Not hospital staff:
▪Not considered safe nor
appropriate interventions
▪Ensure P&P mention
▪Who:
▪Non-hospital
▪Employed
▪Contracted law
enforcement
▪Purpose
▪Custody
▪Detention
▪Public Safety
18

19. Restraint Chair Used by Law Enforcement
▪Emergency restraint
chair
▪Manufacturer states
used for safe
transports to hospital
or court
▪Safely restrains a
combative or self-
destructive person
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20. Items to Document
▪Skin integrity
▪Circulation
▪Respiration
▪I&O
▪Level of supervision
appropriate to meet
patient’s safety need
▪Hygiene
▪Any injuries
▪Continued need for use
▪Adequate justification for
continued use
20

21. JOINT COMMISSION
RESTRAINTS AND
SECLUSION

22. 22
The End Questions???
▪Laura A. Dixon, Esq.
▪BS, JD, RN, CPHRM
▪President, Healthcare Risk
Education and Consulting, LLC
▪303-955-8104
▪[email protected]
2222
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