Restraints Interpretive Guideline: Questions answered

Accreditation Connection, November 13, 2008

Editor’s note: The following question and answer session took place during HCPro’s September 18 audio conference “CMS Interpretive Guidelines: Understand Changes and Challenges for Restraint, Infection Control.” Speaker Susan Hendrickson, MHRD/OD, RN, CPHQ, FACHE, director of clinical quality and patient safety at the Via Christi Wichita (KS) Health Network, answered questions from the field on new restraint requirements.

Q. If a patient is in restraints and it looks like he can do without them, and I take them off, can I then put them back on if, after 30–40 minutes, it looks like he is going to need them after all?

A. No, you may not. That is called a trial release, and a trial release constitutes an as-needed situation. Once a staff member ends an order for restraint intervention, the staff member has no authority to reinstate it without a new order.

Using your example, if the patient is released because a staff member assesses that he or she didn’t need to be in restraint, and the patient later exhibits behavior indicating otherwise, the staff member must go back and get an order.

Q. If a patient is removed from restraints before the time limit for the physician to come in and assess him or her, does the physician still have to perform the assessment?

A. The physician still has to come in and assess the patient to give the order. But you’re better off if you can get the patient out of restraints before the time limit ends. So it’s fine to take the patient out of the restraints ahead of time.

The physician needs to document that the short period of time during which the patient was in restraints was okay with the patient.

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