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Q&A: Does CMS differ from The Joint Commission in stating which practitioners can order a restraint?

Credentialing & Verification Update, July 4, 2007

A: The conditions of participation say a restraint can be ordered by a physician or licensed independent practitioner and it refers to law 482.12(c). CMS has defined an LIP as "a doctor of medicine or osteopathy." However, the rule then goes on to say, "This provision is not to be construed as limiting the authority to delegate tasks to other qualified healthcare personnel to the extent recognized under state law or the state's regulatory mechanism.

CMS is saying the same thing as The Joint Commission, which states, "This is not to be construed to limit the authority of doctors of medicine to delegate tasks to physician assistants, advanced practice nurses, to the extent recognized by state law and hospital policy."

So, if you credential a practitioner, you must ensure that he or she is appropriately privileged to order restraint and seclusion. Or, if you have a job description for the practitioner, ensure that this is clearly articulated in the job description. CMS (482.12) enables nonphysicians to order restraint and seclusion as long as state law allows it.

Editor's note: Questions and topic suggestions can be e-mailed to CVU at mcoler@hcpro.com. We'll find an expert or resource to tackle the credentialing or verification issues that are challenging you.

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