BETTER, MORE EXTENSIVE TRAINING OF STAFF REQUIRED
Health care workers who employ physical restraints and seclusion when treating patients must undergo new, more rigorous training to assure the appropriateness of the treatment and to protect patient rights, according to a regulation published in the Federal Register today by the Centers for Medicare & Medicaid Services (CMS).
The patients’ rights regulations set forth, as a condition of participation (CoP) in the Medicare and Medicaid programs, the expectation that health care facilities will protect the rights of patients. These protections are part of Medicare’s revised CoP requirements that hospitals must meet. The requirements apply to all participating hospitals including short-term, psychiatric, rehabilitation, long-term, children’s and alcohol/drug treatment facilities.
“Through this regulation, CMS will hold all hospitals accountable for the appropriate use of restraint and seclusion,” said Leslie V. Norwalk, acting administrator of CMS. “Today’s action reinforces this administration’s commitment to patient safety and the delivery of high quality health care services.”
“These new rules demonstrate our commitment to advancing patient safety and patient rights in health care facilities,” said Eric B. Broderick, D.D.S., M.P.H., Acting Deputy Administration at HHS’ Substance Abuse and Mental Health Services Administration. “Today we are taking needed steps to solidify training requirements and essential reporting to reduce and ultimately eliminate seclusion and restraints.”
To address concerns about the improper use of restraints and seclusion and in response to the 4,000 public comments received on the interim final rule, the final regulation strengthens the staff training standard and specifies components of the training. The rule also expands the category of practitioners who may conduct patient evaluations when a restraint or seclusion tactic has been implemented.
CMS currently requires that a patient be evaluated “face-to-face” within an hour of a patient being restrained or secluded for the management of violent or self-destructive behavior. Prior to this rule, these actions had to be reviewed within that hour by a physician or “other licensed independent practitioner (LIP).” Today’s action expands that list to include a trained registered nurse (RN) or physician assistant (PA). The rule requires, however, that when an RN or PA performs the 1-hour-rule evaluation, the physician or other LIP treating that patient be consulted as soon as possible.
The basic rights specified in the regulation include a patient’s right to notification of his or her rights in regard to their care, privacy and safety, confidentiality of their records, and freedom from the inappropriate use of all restraints and seclusion, in all hospital settings.
In the development of this final rule, CMS has been sensitive and responsive to the comments of the provider communities, protection and advocacy associations, private citizens, and the health care community in general. The intent of this regulation is to ensure the protection of each patient’s physical and emotional health and safety. In this final rule, CMS has addressed public comments without compromising these protections.
Under the new regulations, hospitals must provide the patient or family member with a formal notice of their rights at the time of admission. These rights include freedom from restraints and seclusion in any form when used as a means of coercion, discipline, convenience for the staff, or retaliation.
Stricter standards for when a healthcare facility must report the death of a patient associated with the use of restraints and seclusion have also been adopted with this rule.
The regulation is in today’s Federal Register and will become effective on February 06, 2007. It can be found at http://frwebgate2.access.gpo.gov/cgi-bin/waisgate.cgi?WAISdocID=835580397202+0+0+0&WAISaction=retrieve.