Joint Commission Behavioral Health Update (Excerpt of the June Newsletter from Barrins & Associates)
Are there any new requirements in the new restraint and seclusion standards? Yes, in the following areas: * Written modification to the treatment plan when restraint or seclusion is used (PC.03.05.03 EP 2) * In person re-evaluation by the LIP every 24 hours instead of 8 hours for adults and 4 hours for 17 years and under (PC.03.05.05 EP 5) * Training requirements for physicians and other authorized LIPs (PC.03.05.09 EP 1) * Definition of what constitutes the uses of medications as a restraint (PC.03.05.04 EP 1)
Are there any current requirements for restraint and seclusion that are not included in the new standards? Yes, in the following areas: * Staffing levels * Initial assessment of the patient regarding restraint or seclusion risks and techniques to help minimize use of restraint or seclusion * Informing clinical leaders regarding multiple episodes of restraint or seclusion * Patient debriefing following restraint or seclusion * Data collection and PI activities related to restraint and seclusion
What has not changed? * Restraint or seclusion is to be used safely and only when clinically justified or warranted by patient behavior that threatens physical safety * Restraint or seclusion is based on an individual order * Monitoring and evaluation of patients in restraint or seclusion * Written policies regarding restraint and seclusion * Medical record documentation of use of restraint or seclusion * Staff training on the use of restraint and seclusion
Do these changes to the restraint and seclusion standards apply to Behavioral Health organizations that use restrain and /seclusion? * These changes do not apply to Behavioral Health organizations surveyed under the Behavioral Health Manual. The current restraint and seclusion standards in the 2009 BH manual (PC.12.10 - PC.PC.12.90) remain in effect at this time. TJC plans to update the automated PPR and the E-dition of the standards by July 1, 2009 to include the CMS related changes. They also plan to publish FAQs on the new restraint and seclusion standards in the near future.
