How do the new standards differ from the old ones?
• There is one set of standards based on the need for restraint or seclusion.
• Standards are tied to behavior of the patient regardless of the cause of the behavior.
• Note: Physician assistants who have been trained to safely implement the use of restraint or seclusion can evaluate, initiate, and monitor patients in restraint or seclusion.
Joint Commission Standards*
Standard PC.03.05.01 The [organization] uses restraint or seclusion only when it can be clinically justified or when warranted by patient behavior that threatens the physical safety of the patient, staff, or others.
Standard PC.03.05.05 The [organization] initiates restraint or seclusion based on an individual order.
EP 1 A physician or other authorized licensed independent practitioner primarily responsible for the patient's ongoing care orders the use of restraint or seclusion in accordance with hospital policy and law and regulation.
Note: The definition of -physician is the same as that used by the Centers for Medicare & Medicaid Services (CMS)
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EP 3 The attending physician is consulted as soon as possible, in accordance with hospital policy, if he or she did not order the restraint or seclusion.
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EP 5 Unless state law is more restrictive, every 24 hours, a physician or other authorized licensed independent practitioner primarily responsible for the patient's ongoing care sees and evaluates the patient before writing a new order for restraint or seclusion used for the management of violent or self-destructive behavior that jeopardizes the immediate physical safety of the patient, staff, or others in accordance with hospital policy and law and regulation.
Standard PC.03.05.07 The [organization] monitors patients who are restrained or secluded.
EP 1 Physicians or other licensed independent practitioners or staff who have been trained in accordance with 42 CFR 482.13(f) monitor the condition of patients in restraint or seclusion. (See also PC.03.05.17, EP 3)
Standard PC.03.05.11 The [organization] evaluates and reevaluates the patient who is restrained or secluded.
EP 1 A physician or other licensed independent practitioner responsible for the care of the patient evaluates the patient in-person within one hour of the initiation of restraint or seclusion used for the management of violent or self-destructive behavior that jeopardizes the physical safety of the patient, staff, or others. A registered nurse or a physician assistant may conduct the in-person evaluation within one hour of the initiation of restraint or seclusion; this individual is trained in accordance with the requirements in PC.03.05.17, EP 3.
EP 2 When the in-person evaluation (performed within one hour of the initiation of restraint or seclusion) is done by a trained registered nurse or trained physician assistant, he or she consults with the attending physician or other licensed independent practitioner responsible for the care of the patient as soon as possible after the evaluation, as determined by hospital policy.
* The preceding Standards and EPs address issues of probable interest or concern to physician assistants and their practice. Please consult the following document for the full set of restraint and seclusion Standards and EPs.
Source: The Joint Commission, Revised 2009 Accreditation Requirements as of March 26, 2009: Hospital Accreditation Program, Chapter: Provision of Care, Treatment, and Services, pp. 14-19.
