Issue link: https://blog.providence.org/i/1541294
Restraints Use of restraints must be in accordance with the practitioner's order who is responsible for the patient's care and must follow the system policy. Please take a moment to familiarize yourself with the policy for acute care hospitals: PSJH-CLIN-1216 Restraint for Non-Violent Non-Self Destructive Behavior and PSJH-CLIN-1217 Restraint for Violent/Seclusion/ Self-Destructive Behavior. 1. A restraint order can NOT be written as a standing order or a PRN order. 2. A discontinued restraint order can NOT be restarted under the same order, but will require a new order. A trial release order is not permitted, as this constitutes a PRN use of restraint. 3. If restraints are ordered by a provider other than the attending, the attending LIP must be notified within one hour of the initiation of the restraint. 4. Patients in restraints MUST have an active LIP order. A verbal order must be verified and countersigned within 48 hours. If an emergency application of restraints is required, CMS standards state "order must be obtained during the emergent application or immediately after." 5. Each order for behavioral (violent) restraint may only be obtained and renewed in accordance with the following limits for up to a total of 24 hours. The provider must see the patient face-to-face within one (1) hour after the initiation of the intervention (CMS SOM Appendix A) and referenced in the policy with this language "For patients engaged in involuntary/uncontrollable self-injury, a standing PRN order may be applied in accordance with specific parameters established in the treatment plan. The requirements for management of violent or self-destructive behaviors do not apply. " Each order is renewed based upon an RN assessment and the consultation with the physician every: There are some behavioral health units that the trained RN can do the 1-hour face-to-face and then they must call and consult with the physician after completing that. We have language related to this now in the addendum at the end of the violent policy. Ordering limits for behavior (violent) restraint: • Up to four (4) hours for adults age 18 and older • Up to two (2) hours for children and adolescents ages 9 to 17 • Up to one (1) hour for patients under age 9 • If restraint is removed prior to the 1 hour, the LIP must still do the evaluation. Orders for behavioral (violent) restraint beyond 24 hours: If a patient remains in restraint 24 hours after the original order, the physician, other LIP, NP or PA must see the patient and conduct a face-to-face re-evaluation before writing a new order for the continued use of restraint (violent). 6. Each order for non-violent restraint are in full force and effect, which includes the day the order was obtained, however non-violent orders are actually episodic, so the order is valid until the restraint is removed. Orders must contain: • Reason for restraint • Type of restraint to be used • Time limited and not to exceed one calendar day (Required for violent restraints. Non-violent is only reason and type) • Date and Time 7. Restraint orders must be reconciled for transferred patients. Provider Education Training Manual 24 |