CMS Restraint and Seclusion (Most Problematic Standard for Hospitals and 2019 Change)

Why Should You Attend:

Do you know that the number one area of deficiencies in the CMS CoP is regarding restraints? CMS issued a memo summarizing all of the deficiencies against hospitals which is updated quarterly.

This program by expert speaker Sue Dill Calloway, RN, MSN, JD, will discuss the most problematic standards in the restraint section. This program also discusses the proposed changes to restraint published in the Hospital Improvement Act. This will help you assess your preparedness if a CMS surveyor shows up at your hospital tomorrow, and enhance your staff’s understanding of all of the 50 pages of the CMS interpretive guidelines.

This session will also discuss the requirements for an internal log and what must be in the log for patients who die in one or two soft wrist restraints. Additionally, it will include what must be documented in the medical record and discuss the reporting requirements for patients who die in restraints and within 24 hours of being in a restraint.

Learning Objectives:

• Know the CMS restraint requirement of what a hospital must document in the internal log if a patient dies within 24 hours with having two soft wrist restraints on
• Why CMS requires that all physicians and others who order restraints must be educated on the hospital policy?
• Understand CMS’ requirements for education of staff on restraint
• What are specific things that CMS requires to be documented in the medical record for the one hour face to face evaluation on patients who are violent and/or self-destructive?

Areas Covered in the Webinar:

This webinar will cover the 50 pages of restraints standards that hospitals must follow according to CMS. It will cover all the CMS requirements on restraints which includes the following sections:

• Right to be free from restraint
• Number of deficiencies
• Providing copy of right to patients
• Restraint protocols
• Proposed changes in the hospital improvement act
• PA to order and change from LIP to LP
• CMS deficiency reports
• CMS changes effective to internal log and soft wrist restraints
• Most current manual
• Medical restraints
• Behavioral health restraints
• Violent and self-destructive behavior
• Definition of restraint and seclusion
• Manual holds of patients
• Leadership responsibilities
• Two soft wrist restraints, internal log and documentation
• Culture of safety
• Drugs used as a restraint
• Standard treatment
• Learning from each other
• Restraints does not include
• Side rails, forensic restraints, freedom splints, immobilizers
• Assessment
• Need order ASAP
• Order from LIP and notification of attending physician ASAP
• Documentation requirements
• Least restrictive requirements
• Alternatives
• RNs and One hour face to face assessment
• Training for RN doing one hour face to face assessment
• New training requirements
• New death reporting requirements
• Ending at earliest time
• Revisions to the plan of care
• PI requirements
• Time limited orders
• Renewing orders
• Staff education
• First aid training requirement
• Stricter state laws
• Monitoring of patient in R/S
• Joint Commission Hospital Restraint standards and differences from CMS

Who Will Benefit:

All nurses with direct patient care, Compliance Officer, Chief Nursing Officer, Chief of Medical Staff, COO, Nurse Educator, ED Nurses, ED Physicians, Medical staff coordinator, Risk Manager, Patient Safety Officer, Senior Leadership, Hospital Legal Counsel, Chief Risk Officer, PI director, Joint Commission Coordinator, Nurse Manager, Quality Director, Chief Medical Officer, Security Guard, Accreditation and Regulation Staff and others responsible for compliance with hospital regulations and anyone involved in the restraint or seclusion of patients. Persons responsible for rewriting the hospital policies and medical staff bylaws should attend. This also includes staff who remove and apply them as part of their care such as radiology techs, ultra sound technologists, transport staff and others.

Sue Dill Calloway
chief learning officer, Emergency Medicine Patient Safety Foundation

Sue Dill Calloway, RN, MSN, JD, is a nurse attorney, a medical legal consultant and the past chief learning officer for the Emergency Medicine Patient Safety Foundation. She is the immediate past director of Hospital Patient Safety and Risk Management for The Doctors Company. She is currently president of Patient Safety and Health Care Education and Consulting. Sue was a medical malpractice defense attorney for many years and a past director of risk management for the Ohio Hospital Association. She was in-house legal counsel for a hospital in addition to being the privacy officer and compliance officer.

She has done many educational programs for nurses, physicians, and other health care providers. She has authored over 102 books and numerous articles. Sue is a frequent speaker and is well known across the country in the area of healthcare law, risk management, and patient safety. She has taught many educational programs and written many articles on compliance with the CMS and Joint Commission restraint standards.

Topic Background:

Did you know that the number one area of deficiencies in the CMS CoP is regarding restraints? CMS issued a memo summarizing all of the deficiencies against hospitals which is updated quarterly. This program will discuss the most problematic standards in the restraint section. If a CMS surveyor showed up at your hospital tomorrow would you be prepared? Does your staff understand all 50 pages of the CMS interpretive guidelines? This program also discuss the proposed changes to restraint published in the Hospital Improvement Act.

Did you know that both CMS and Joint Commission require hospital staff to be educated on restraint and seclusion interpretive guidelines? This program can be used to help hospitals meet this requirement. CMS also says that restraint training must be on-going so you can’t just provide training at orientation and forget about it. Did you know that CMS has ten pages of training requirements?

This program will discuss the requirements for an internal log and what must be in the log for patients who die in one or two soft wrist restraints. It will include what must be documented in the medical record also. It will also discuss the reporting requirements for patients who die in restraints and within 24 hours of being in a restraint.

As discussed, Restraint and Seclusion is a hot spot with both CMS and the Joint Commission and a common area where hospitals are cited for being out of compliance. The restraint policy is one of the hardest to write and understand in healthcare today.

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