Hospitals criticize HCFA rule on patient restraint
Hospital administrators are opposing a regulation issued by the Health Care Financing Administration (HCFA) that spells out tough new policies regarding the restraint and seclusion of patients in acute-care facilities.
Earlier this year, HCFA, which administers the Medicare and Medicaid programs from Baltimore, promulgated an interim final rule that requires a physician to make a "face-to-face evaluation" before any patient is to be restrained or secluded.
It also imposes a time limit of no more than one hour for the evaluation to occur before a patient is actually restrained or moved to a secluded area of the facility.
Although the regulation is likely to have a greater effect on long-term care facilities, critical care nurses are subject to the same provisions. In literal terms, the rule requires that even unconscious patients who pose no physical threat to themselves or a nurse must be evaluated by a physician before restraints can be applied.
The regulation makes following the rule a condition of participation for providers that means hospitals risk loss of their Medicare and Medicaid contracts for violations.
The American Hospital Association (AHA) hotly contested the new rule, arguing that HCFA did not provide sufficient time for public comment. The AHA voiced concerns about employee safety.
According to the Justice Department, nearly half of all nonfatal hospital workplace assaults stem from patients, although most occur at mental health facilities.
In a letter to HCFA, AHA Adminstrator Nancy-Ann DeParle urged the agency to monitor the impact of the regulation. "Overuse may be a problem, but underuse is just as dangerous," she wrote.
HCFA officials say they were concerned about patient safety following reports of patient deaths resulting from restraint by hospital staff. Most of those incidents occurred in nursing homes and psychiatric hospitals.
However, all acute-care facilities are covered by the new rule. The regulation was issued as part of a package of patient protection regulations to the Medicare and Medicaid handbook and went into effect on an interim basis in September. Officials of the American Association of Critical Care Nurses in Aliso Viejo, CA, had no comment on the matter.
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