Overview:
Do you know the recent change made in restraints by CMS, effective November 29, 2019? CMS changes the term from LIP (licensed independent practitioner to LP (licensed practitioner).
This allows hospitals to allow PAs to write orders for restraints in
states where they were considered to be dependent practitioners. The
changes will be discussed in detail.
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?
Did
you know any physician or provider who orders restraint must be trained
in the hospital’s policy? Did you know that both CMS and Joint
Commission require hospital staff to be educated on restraint and
seclusion interpretive guidelines on an annual basis? This program can
be used to help hospitals meet this requirement. CMS also says that
restraint training must be on-going so you cannot 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 new electronic 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.
CMS has issued interpretive
guidelines on restraint and seclusions for hospitals. This program will
simplify and take the mystery out of those 50-page restraint and
seclusion interpretive guidelines. It will provide a crosswalk to the
Joint Commission standards. Avoid the restraint nightmare now and let us
take the mystery out of these confusing regulations by attending this
program.
Every hospital that accepts Medicare patients will have
to comply with the interpretive guidelines even if the hospital is
accredited by the Joint Commission, HFAP, CIHQ, or DNV Healthcare.
Hospitals will need to make sure their policies and procedures comply
with these.
Joint Commission and CMS both require restraint
training to staff. There is also a requirement that physicians and
anyone who writes an order for restraints will have to be educated on
the hospital’s policy. The guidelines explain the training requirements
for the RN doing the one-hour face to face visits for patients who are
violent and or self destructive. There are basically 21 rules covered by
the CMS interpretive guidelines.
The Joint Commission standards
on restraint and seclusion will be reference and are now closer in the
crosswalk. Patient safety is at risk and patients have been injured or
died from improper restraint usage.
Areas Covered in the Session:
- Right to be free from restraint
- Number of deficiencies
- Providing copy of right to patients
- Restraint protocols
- Final changes in the hospital improvement rule
- 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 required
- Stricter state laws
- Monitoring of patient in R/S
- Joint Commission Hospital Restraint standards and differences from CMS
Learning Objectives
- Define
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
- Recall that CMS requires that all physicians and others who order restraints must be educated on the hospital policy
- Describe that CMS has restraint education requirements for staf
- Discuss
that CMS has specific things that need to be documented in the medical
record for the one-hour face to face evaluation on patients who are
violent and or self destructive
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
- Patient safety officer
- Senior leadership
- Hospital legal counsel
- Risk Manager
- Chief Risk Officer
- PI director
- Joint Commission coordinator
- Nurse managers
- Quality director
- Chief medical officer
- Security guards
compliance officer - 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 that remove and apply them as part of their care such as radiology
techs, ultrasound, technologists ,transport staff and others