Greeley Reflections

Accreditation Connection, July 13, 2009

Time to start working on restraint

Part 4 of 4

Last week we continued our discussion on restraints policies. Today, let’s look at the remaining standards and EPs in our discussion. We recommend measuring compliance with your policy. Here are some additional areas to focus on the “direct impact” requirements (summarized below):

PC.03.05.11, EP1 requires a one-hour face-to-face evaluation of the violent or self-destructive patient by a responsible physician or an appropriately trained registered nurse or physician assistant.

Suggestion: Ensure that all registered nurses who staff the emergency department or the behavioral healthcare unit have documented training the monitoring of violent/self-destructive patients.

PC.03.05.11, EP2 requires a nurse or PA who performs the one-hour face-to-face evaluation of violent or self-destructive patients to consult with the responsible physician as soon as possible after initiation of restraint.

Suggestion: When possible have the physician perform the one-hour reassessment. “Hard wire” documentation of consultation with the physician when this assessment is performed by the nurse or a PA. Do not rely on a separate timed note.

PC.03.05.11, EP3 specifies the content of the one-hour evaluation of the violent patient.

Suggestion: Hard code this documentation into forms or computer templates.

PC.03.05.13, EP1 requires the continuous observation of patients who are simultaneously restrained and secluded.

Suggestion: If video equipment is used for monitoring, make sure there is also an audio signal from within the room. (Remember, this only applies to patients who are restrained and secluded at the same time.)

There are plenty of other requirements to worry about. We suggest starting here, with the Category A, direct impact requirements.

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