Comply with new restraint and seclusion regulations
More rigorous training is required for staff who use restraints and seclusion to curb violent or self-destructive behavior, says a final rule published by the Centers for Medicare & Medicaid Services (CMS), effective Jan. 8, 2007.1
The rule also adds trained registered nurses and physician assistants to the category of practitioners who may conduct the "face-to-face" evaluation required within an hour of a patient being restrained or secluded. A nurse or physician's assistant who performs the evaluation must consult a physician or other licensed independent practitioner as soon as possible, however. (To download a complete copy of the final rule, go to www.cpidirections.com/AA/Advisories.htm and at the CMS logo, click on "Medicare/Medicaid Final Rule: Patients' Rights — Restraints & Seclusion.")
At Harborview Medical Center in Seattle, ED nurses receive training in restraint and seclusion, including documentation requirements, during orientation. "Then our ED clinical educator intensively reviews those requirements with all new hires," says Ed Dwyer-O'Connor, RN, psychiatric emergency services manager. "We also have unit-based trainings with regard to restraint management within the ED, which are led by me."
In addition to that training, ED nurses receive eight hours of nonviolent crisis intervention, based on a module from the Brookfield, WI-based Crisis Prevention Institute. The training emphasizes de-escalation and other restraint alternatives, with physical intervention and restraints used only as a last resort.
"We also do an hour of training at the end of this, to review with staff what their roles are if we need to put hands on the patient to keep them and us safe," says Dwyer-O'Connor. All nurses are familiar with the continuous 1:1 monitoring of patients in restraints when they are used, and restraint use is regularly audited in the ED, he adds.
"I think we are well placed to handle all changes put forth by CMS," says Dwyer-O'Connor. "With regard to the one hour face-to-face evaluation, we have access to plenty of physicians on-site, so we have not trained our nurses for that. So it will not change our ability to comply."
Reference
- 71 Fed Reg 71,377-71,428 (Dec. 8, 2006).
Resource
For more information on the Nonviolent Crisis Intervention training program, contact: Crisis Prevention Institute, 3315-H N. 124th St., Brookfield, WI 53005. Telephone: (800) 558-8976. Fax: (262) 783-5906. E-mail: [email protected].
More rigorous training is required for staff who use restraints and seclusion to curb violent or self-destructive behavior, says a final rule published by the Centers for Medicare & Medicaid Services (CMS), effective Jan. 8, 2007.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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