Best Practices for Managing Hospital Restraint and Seclusion under CMS Guidelines

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Restraint and seclusion are major compliance concerns for hospitals, drawing attention from both CMS and the Joint Commission. They are the primary areas where hospitals often receive citations for non-compliance. The CMS Conditions of Participation (CoP) have a specific requirement related to restraints, which is the leading cause of deficiencies. Hospitals accepting Medicare patients must adhere to CMS interpretive guidelines on restraint and seclusion, regardless of their accreditation by Joint Commission, HFAP, CIHQ, or DNV Healthcare. The Joint Commission also has standards on restraint and seclusion that closely align with the CMS CoPs. Register, https://conferencepanel.com/conference/cms-hospital-restraint-and-seclusion

Healthcare

CMS Hospital Restraint and Seclusion
Navigating the Most Problematic
CMS Standards and Proposed Changes
Speaker
Laura A. Dixon
(BS, JD, RN, CPHRM)

About Speaker
Laura A. Dixon served as the Director, Facility Patient Safety and Risk Management,
and Operations for COPIC from 2014 to 2020. In her role, Ms. Dixon provided patient
safety and risk management consulting and training to facilities, practitioners, and staff in
multiple states. Such services included the creation of and presentations on risk
management topics, assessment of healthcare facilities; and development of programs
and compilation of reference materials that complement physician-oriented products.
Ms. Dixon has more than twenty years of clinical experience in acute care facilities,
including critical care, coronary care, peri-operative services, and pain management.
As a registered nurse and attorney, Laura holds a Bachelor of Science degree from Regis
University, RECEP of Denver, a Doctor of Jurisprudence degree from Drake University
College of Law, Des Moines, Iowa, and a Registered Nurse Diploma from Saint Luke’s
School Professional Nursing, Cedar Rapids, Iowa. She is licensed to practice law in
Colorado and California.

Description
Restraint and Seclusion is a hot spot with both CMS and the Joint Commission and
an area where hospitals are frequently cited for being out of compliance. The
number one area of deficiencies for a specific requirement in the CMS CoP is
regarding restraints. This program will discuss the most problematic standards in
the restraint section.
CMS has fifty pages of interpretive guidelines on restraint and seclusions for
hospitals. Every hospital that accepts Medicare patients will have to comply with
the interpretive guidelines even if the hospital is Joint Commission, HFAP, CIHQ,
or DNV Healthcare accredited.
CMS made changes regarding restraints in 2019. Specifically, CMS changed the
term from LIP (licensed independent practitioner to LP (licensed practitioner). The
change allows PAs to write orders for restraints in states where they are considered
dependent practitioners.

Learning Objectives
▪ Define the CMS restraint requirement of what a hospital must document in the
internal log if a patient dies within 24 hours with two soft wrist restraints on.
▪ Recall that CMS requires that all physicians and others who order restraints must
be educated on the hospital policy.
▪ Describe that CMS has restraint education requirements for staff.
▪ Discuss that CMS has specific things that need to be documented in the medical
record for the one-hour face-to-face evaluation of patients who are violent and or
self-destructive.

Session Outline
▪ Introduction to CoP Manual
▪ CMS deficiencies and access
▪ CMS changes to restraint & seclusion
▪ Definition of restraint and seclusion
▪ Leadership responsibilities
▪ Drugs used as a restraint
▪ Revisions to the plan of care
▪ Monitoring of patients in R/S
▪ Conditions of Participation for CAH
▪ Behavioural health restraints
▪ Medical restraints
▪ Documentation requirements
▪ Restraints do not include
▪ Joint Commission Hospital Restraint
standards

▪ All nurses with direct patient care
▪ Compliance officer
▪ Chief nursing officer
▪ Chief of medical staff
▪ Nurse Educator
▪ ED nurses
▪ ED physicians
▪ Medical staff coordinator
▪ Patient safety officer
▪ Hospital legal counsel
▪ Chief Risk Officer
▪ PI director
▪ Joint Commission coordinator
▪ Nurse managers
▪ Quality director
▪ Chief medical officer
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