Requirements revised for restraints and seclusion
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has adopted revised requirements for restraint and seclusion in hospitals that rely on JCAHO accreditation for Medicare deemed status purposes.
The revisions state that hospitals wishing to use accreditation to qualify for Medicare certification must comply with the Health Care Financing Administration’s (HCFA) "one-hour rule." That rule requires that a physician or other licensed independent practitioner conduct a face-to-face evaluation of an individual placed in restraint or seclusion for behavioral health reasons within one hour of the initiation of the intervention.
The new JCAHO requirement is effective immediately. The HCFA requirements relating to use of restraint and seclusion were issued in an interim final rule that became effective in August 1999. HCFA issued interpretative guidelines for these requirements in June 2000. In May 2000, JCAHO released new standards for the use of restraint and seclusion.
Those standards restrict the uses of restraint and seclusion for behavioral health reasons to emergency situations in which there is an imminent risk that individuals may physically harm themselves or others. Even then, restraint is to be used as a last resort.
The standards become effective Jan. 1, 2001, and contain requirements for the ongoing assessment and re-evaluation of patients in restraints that are more rigorous than those set forth in HCFA’s regulations. They emphasize educating staff on how to avoid the need for restraint and how to use restraint properly when it cannot be avoided.
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