Seclusion and Restraint: Final Rule on Patients' Rights
Better, More Extensive Training of Staff Required
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SAMHSA's Training Curriculum (SMA 06-4055) is available on CD ROM |
Health care workers who employ restraints and seclusion when caring for patients must undergo new, more rigorous training to ensure the appropriateness of care and to protect patients’ rights, according to a regulation published recently in the Federal Register by the Centers for Medicare & Medicaid Services (CMS).
The intent of this final regulation is to ensure the protection of each patient’s physical and emotional health and safety. The regulation strengthens staff training standards and specifies training components. It also expands the category of practitioners who may conduct patient evaluations when a restraint or seclusion tactic is used.
CMS developed the final rule in conjunction with SAMHSA and considered comments on the interim 1999 rule from provider communities, protection and advocacy associations, private citizens, and the health care community in general.
CMS set forth patients’ rights regulations for health care facilities as a condition of participation (CoP) in the Medicare and Medicaid programs. 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.
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Patient Evaluation
Currently, a “face-to-face” evaluation is required within 1 hour for a patient in restraint or seclusion to manage violent or
self-destructive behavior that jeopardizes the immediate physical safety of the patient, or a staff member, or others.
Prior to this rule, these actions had to be reviewed within the hour by a physician or “other licensed independent practitioner (LIP).”
The final rule 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.
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Basic Patient Rights
The regulations specify that hospitals must provide patients and their family members with a formal notice of basic rights at the time of admission. These include care, privacy, and safety; confidentiality of records; and freedom from the use of restraints and seclusion for coercion, discipline, retaliation, or staff convenience.
 The final rule also includes stricter standards for health care facilities reporting the death of a patient associated with the use of restraints and seclusion.
The full text of the final rule, as posted in the December 8, 2006, Federal Register, is available online in text and
PDF formats (click on Patients’ Rights) at www.access.gpo.gov/nara/cfr/
waisidx_04/42cfr482_04.html, or as it appeared in a single PDF in the Federal Register at https://www.cms.hhs.gov/
CFCsAndCoPs/downloads/
finalpatientrightsrule.pdf. 
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