Restraint and Seclusion Techniques: Know Your Legal Risks
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Does your facility or its staff understand the risks of utilizing seclusion and restraint? Have you addressed concerns such as: use of seclusion/restraint for staff's own convenience?; use of seclusion/restraint as a threat (e.g., "if you don't stop, you will be put in seclusion")?; use of seclusion/restraint when the behavior might not be imminently threatening?; continuation of seclusion/restraints after behavior is no longer imminently threatening?; proper documentation of less-restrictive measures attempted prior to seclusion/restraint?; proper documentation of conduct justifying the seclusion/restraint?; proper staff training on behavioral interventions?; proper observation of the patient in seclusion/restraint, and provision of nursing care?
This OnDemand Webinar is designed for the individuals responsible for staff training or risk management related to restraint and seclusion, to provide guidance about how to comply with Medicare's Conditions of Participation and how to minimize the various risks associated with seclusion and restraint - staff injuries, patient injuries, civil liability, re-traumatizing the patient, and investigation by administrative agencies, to name a few. The program also will explore the strategies recommended by mental health program directors to reduce the reliance on seclusion and restraint.
- You will be able to identify CMS rules regarding restraints and seclusion.
- You will be able to describe the risks of using restraints and seclusion.
- You will be able to discuss proper implementation of restraints and seclusion.
- You will be able to demonstrate documentation of appropriate use of restraints and seclusion techniques.
AuthorsDavid J. Ryan, J.D., Williams Kastner & Gibbs PLLC
Suzanne Thompson Wininger, R.N., B.S.N., J.D., Campbell Thompsom Wininger PLLC
A Historical Perspective
• Patchwork Quilt of State Regulations
- 1985 Task Force of American Psychiatric Association Found Inconsistency With Regard to Definitions of Restraint/Seclusion, Use to Prevent Property Damage, When/How to Conclude Use, etc.
• Youngberg v. Romeo, 457 U.S. 307 (1982), U.S. Supreme Court
- Restraint Is a Drastic Deprivation of Personal Liberty and the Right to Be Free From Undue Bodily Restraint Is the Core of the Liberty Interest Protected by the Due Process Clause From Arbitrary Governmental Action
• Emergence of Clinical Consensus That Restraint and Seclusion Are Safety Interventions of Last Resort and Use Should Be Reduced Significantly and Reserved for Only the Most Emergent Situations
January 2007 - CMS Rules Applicable to All Medicare and Medicaid Participating Hospitals
• Restraint and Seclusion May Only Be Imposed to Ensure the Immediate Physical Safety of the Patient, a Staff Member, or Others and Must Be Discontinued at the Earliest Possible Time
• General Requirements for All Patients, Without Distinction for Medical/Surgical Care and Behavior Management
• Special Requirements for Violent and Self-Destructive Behavior
Implementation - How Is It Working?
• CMS Conditions of Participation and Joint Commission Standards for Restraint and Seclusion
• How Good Is Your Documentation?
• Training Requirements