Description:

In the ever-evolving healthcare landscape, the Center for Medicare and Medicaid Services (CMS) plays a pivotal role in setting and enforcing standards that impact patient care, safety, and the operations of healthcare facilities. One area of continual focus and scrutiny is restraint and seclusion in hospitals. These practices are essential for maintaining a safe and therapeutic patient environment but can also raise complex ethical, legal, and clinical challenges.

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 must 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 restraining orders in states where they are considered dependent practitioners. 

Any physician or provider who orders restraint must be trained in the hospital’s policy. Both CMS and Joint Commission require hospital staff to be educated on restraint and seclusion interpretive guidelines on an annual basis. CMS also says that restraint training must be ongoing, so you cannot just provide training at orientation and forget about it. CMS has ten pages of training requirements. 

Finally, this program will cover The Joint Commission standards on restraint and seclusion, many of which fall closely with the CMS Conditions of Participation. 

The webinar aims to dissect the most problematic CMS standards governing restraint and seclusion in hospital settings, as well as explore the proposed changes for the upcoming year; its objective is to provide healthcare professionals, administrators, and stakeholders with a comprehensive understanding of the evolving landscape to enhance patient care and safety. 

Webinar Highlights:

• Introduction to the CoPs on Restraint and Seclusion.
• Identify the function and fundamental concepts of patient restraint and seclusion.
• Describe the issues of concern regarding patient restraint and seclusion.
• Outline the clinical significance of patient restraint and seclusion. 
• Joint Commission Hospital Restraint standards.
• RNs and One-hour face-to-face assessment.
• CMS has restraint education requirements for staff.
• Success Stories and Ideas for Reducing Restraint/Seclusion in Behavioral Health.
• Identify medical problems that could be causing behavioral changes.

Areas Covered:

• Introduction to CoP Manual
• CMS deficiencies and access 
• Complaint process
• CMS changes to restraint and seclusion
• Conditions of Participation for CAH
• Seclusion – what it is and is not
• Medical restraints
• Behavioral health restraints 
• Definition of restraint and seclusion
• Manual holds of patients, 
• Leadership responsibilities
• Drugs used as a restraint 
• Restraints do not include
• Side rails, forensic restraints, freedom splints, immobilizers,
• Patient assessment
• Need order ASAP
• Order from LP and notification to attending physician 
• Documentation requirements 
• Least restrictive requirements
• RNs and One-hour face-to-face assessment
• Training for RNs doing one-hour face-to-face assessment
• Training requirements
• Death reporting requirements
• Ending at the earliest time
• Revisions to the plan of care
• Time-limited orders 
• Renewing orders 
• Staff education
• First aid training required
• Monitoring of patients in R/S
• Joint Commission Hospital Restraint standards 

Why Should You Attend:

Working in the medical field comes with its hazards. Unfortunately, those same patients can become agitated and violent even in the pursuit of providing aid to those in need. Patient restraint and seclusion is a controversial yet necessary aspect of medicine. Restraint encompasses both physical and chemical procedures. This activity outlines the proper application of patient restraint and seclusion and highlights the role of the interprofessional healthcare team in evaluating and managing a restrained patient. CMS and Joint Commission require hospital staff to be educated annually on restraint and seclusion interpretive guidelines.

Who Should Attend:

• Compliance Officer
• Chief Nursing Officer
• Chief Medical Staff
• ED Nurses and Physicians
• Medical Staff Coordinator
• Risk Manager and PI Director
• Patient Safety Officer
• Hospital Legal Counsel
• Chief Risk Officer
• Joint Commission Coordinator
• Nurse Manager and Nurse Educator
• Quality Director
• Chief Medical Officer
• Security Guards
• Staff that remove and apply them as part of their care include radiology techs, ultrasound technologists, transport staff, and others.

Presenter Information:

Name: Laura A. Dixon

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 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. Prior to joining COPIC, she served as the Director of, Western Region, Patient Safety, and Risk Management for The Doctors Company, Napa, California.

In this capacity, she provided patient safety and risk management consultation to the physicians and staff in the western United States. Ms. Dixon’s legal experience includes representation of clients for Social Security Disability Insurance providing legal counsel and representation at disability hearings and appeals, medical malpractice defense, and representation of nurses before the Colorado Board of Nursing.

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.