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The impetus for reducing restraint use continues to grow with the recent addition of new Medicare regulations designed to protect hospital patients from the inappropriate use of physical restraint. The Medicare regulations are modeled primarily on standards established by the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL.
The Health Care Financing Administration’s (HCFA) new Patients’ Rights Conditions of Par ticipation took effect Aug. 2. The regulations apply to all hospitals that participate in the Med icare and Medicaid programs, including short-term, psychiatric, rehabilitation, long-term, children’s, and alcohol/drug facilities.
Agencies share some requirements
These are some requirements common to both the Joint Commission and HCFA:
• use of restraint or seclusion only when clinically justified;
• consideration of alternatives to restraint or seclusion in specific situations;
• ongoing training of staff in the appropriate use of restraint or seclusion;
• limitations on the time frames for the use of restraint or seclusion;
• continual monitoring, assessment, and reeval uation of the restrained or secluded patient, with the intent of discontinuing restraint or seclusion at the earliest possible time.
HCFA first proposed sweeping changes to its Conditions of Participation in 1997 but decided to extract and finalize the Patients’ Rights Conditions of Participation quickly in response to what critics called increasing threats to the fundamental rights of patients.
The Joint Commission is continuing its efforts to address the inappropriate use of restraint in psychiatric facilities and other behavioral health care settings. A series of public hearings was held earlier this year to receive input from the public and other interested parties regarding the use of restraint. A restraint use task force is evaluating the Joint Commission’s restraint standards, on-site evaluation process, and other means for accessing information about restraint use. The task force is expected to make final recommendations to the Joint Commission Board of Commis sioners by the end of 1999.