Guidelines require frequent patient contact
The new restraint guidelines from the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, contain strict requirements for a patient to be seen frequently by a doctor or other licensed professional.
The following example provided by the Joint Commission illustrates how time requirements would play out in the use of restraint or seclusion with an adult for 24 consecutive hours. The example also illustrates the minimum expectations for participation by a licensed independent practitioner. The Joint Commission stresses that the example does not presuppose that 24 hours is a desirable length of time to restrain or seclude an individual; it is simply an illustration of how multiple cycles of assessment would be expected to occur over a 24-hour time frame.
In this timetable, the citations in parentheses indicate the applicable guideline:
• 0 hour: Initiation of restraint or seclusion (TX.3.4.1). Individual is assessed and continuous monitoring begins (TX.3.6).
• Every 15 minutes: Individual assessed by qualified staff member (TX.3.6).
• Within one hour: Verbal order obtained from a licensed independent practitioner (TX.3.4.3). Order is limited to four hours from the time of initiation TX.3.5).
• Promptly: Face-to-face evaluation by a licensed independent practitioner (TX.3.4.4). (The Joint Commission has not defined "promptly" but may do so when the guidelines are final.)
• End of 4th hour: Authorized, qualified staff reevaluate the individual. If restraint or seclusion continues, either a new order is obtained or the original order is continued (TX.3.7). The new order or continued order is limited to four hours (TX.3.5).
• End of 8th hour: A licensed independent practitioner reevaluates the individual. If restraint or seclusion continues, the licensed independent practitioner furnishes a new order (TX.3.7). The new order is limited to four hours (TX.3.5).
• End of 12th hour: Authorized, qualified staff reevaluate the individual. If restraint or seclusion continues, either a new order is obtained or the order is continued (TX.3.7). The new order or continued order is limited to four hours (TX.3.5).
• End of 16th hour: A licensed independent practitioner reevaluates the individual. If restraint or seclusion continues, the licensed independent practitioner furnishes a new order (TX.3.7). The new order is limited to four hours (TX.3.5).
• End of 20th hour: Authorized, qualified staff reevaluate the individual. If restraint or seclusion continues, either a new order is obtained or the order is continued (TX.3.7). The new order or continued order is limited to four hours (TX.3.5).
• End of 24th hour: A licensed independent practitioner reevaluates the individual. If restraint or seclusion continues, the licensed independent practitioner furnishes a new order (TX.3.7). The new order is limited to four hours (TX.3.5). Clin ical leadership is notified (TX.3.7.1).
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