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Know four key differences
There are several key differences between the Joint Commission on Accreditation of Health care Organizations standards for restraint and the new Health Care Financing Administration (HCFA) requirements, reports Margaret Van Amringe, Joint Commission vice president of external affairs.
If a hospital is accredited by the Joint Com mission, then it is deemed to meet the Medicare requirements, explains Van Amringe. "Eighty-five percent of hospitals are accredited, and these only get an accreditation survey, not a HCFA survey."
However, HCFA’s restraint regulations apply to all hospitals that participate in the Medicare and Medicaid programs. "HCFA does a random survey of 5% of hospitals, to make sure that the [Joint Commission] surveys are valid," she notes.
The 15% of hospitals that are not accredited are surveyed by HCFA, which contracts with state survey agents.
"However, if there is a complaint, HCFA has the option of surveying the hospital directly itself to see if the complaint is substantiated. Or they can ask the [Joint Commission] to go in," says Van Amringe.
But it’s possible to be accredited by the Joint Commission and still not meet HCFA’s new stringent requirements. "That’s why it’s important for us to have some agreement with HCFA about the restraint standards," she stresses. (See box, top of page, for details on ordering the Joint Commis sion standard. See brief on the Joint commission’s upcoming revised standards, at right.)
Some of the areas where the Joint Commission is not consistent with the new HCFA regulations may change when the Joint Commission comes out with new standards, reports Van Amringe. "We were already deeply in the process of drafting new changes to our standards, when HCFA came out with theirs," she says.
Here are how the Joint Commission and HCFA standards compare:
o Behavioral vs. medical/surgical standards.
HCFA: Requires a physician or other licensed practitioner to perform a face-to-face evaluation within one hour of the time restraints are applied.
Joint Commission: Requires the physician to see the restrained patient as soon as possible, but no later than 12 hours after restraints are applied.
o Use of restraints for medical/surgical patients.
HCFA: Each order for restraints must be done by a physician. The standards do not permit the use of physician-developed protocols.
Joint Commission: Protocols may be used, which means that medical staff can approve how restraints are used for routine purposes.
o Deaths caused by restraints.
HCFA: All deaths due to restraints are required to be reported to HCFA.
Joint Commission: There is no requirement to report restraint-related deaths to the Joint Com mis sion. However, under the Joint Commission’s senti -nel event policy, a death related to restraints must be recorded, along with proof that a root cause analysis has been performed, and made available on site for review during a survey.
o Appropriate use of restraints.
HCFA: Restraints can be used only in emergency situations, unless it’s documented that all other types of interventions have failed.
Joint Commission: Restraints are encouraged to be used only as a last resort, but it’s not specified that they may be used only in emergency circumstances. Restraint use is permitted for some behavioral management situations.