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Joint Commission Standards -
Restraint and Seclusion
Standards in the Joint Commissions’ Comprehensive Accreditation Manual for Hospitals (CAMH) differentiate between restraint of medical/surgical (nonpsychiatric) patients and restraint/seclusion of behavioral health patients.
Medical/Surgical Restraints
In the section of the CAMH addressing medical/surgical restraints, standard PC.11.40 states, “Any use of restraint (to which these standards apply) is initiated pursuant to either an individual order (standard PC.11.50) or an approved protocol (standard PC.11.60), the use of which is authorized by an individual order.”
The “Elements of Performance” for Standard PC.11.40 state,
“1. Restraint (except for restraint initiated under a protocol as described in standard PC.11.60) is used upon the order of a licensed independent practitioner.*
*This standard is not to be construed to limit the authority of a licensed independent practitioner to delegate tasks to other qualified health care staff (this is, physician assistants and nurse practitioners) to the extent recognized under state law or a state's regulatory mechanism. In states that allow this delegation, hospitals that permit these individuals to order restraint for medical or surgical reasons are considered to be in compliance with this standard."
[CAMH Refreshed Core, January 2008, page PC-28]
The introduction to the section, Applicability of these Restraint Standards in Acute Medical and Surgical (Nonpsychiatric) Care, states:
“Standards PC.11.10 through PC.11.100 apply to the use of restraint in medical and surgical care, which includes patients receiving pediatric, obstetrical, or rehabilitation care. This includes patients of any age who are as follows:
- Hospitalized in an acute care hospital to receive medical or surgical services
- In the emergency department for assessment, stabilization, or treatment for other than behavioral health care reasons
- In medical observation beds
- Undergoing same-day surgical or other ambulatory health care procedures
- Undergoing rehabilitation as an outpatient or inpatient
“The specific device used to restrain a patient does not in itself determine whether these standards apply. Rather, it is the device’s intended use (such as physical restriction), its involuntary application, and/or the identified patient need that determines whether use of the device triggers the application of these standards. Therefore, these standards do not apply to the following:
- Standard practices that include limitation of mobility or temporary immobilization related to medical, dental, diagnostic, or surgical procedures and the related post-procedure care processes (for example, surgical positioning, intravenous arm boards, radiotherapy procedures, protection of surgical and treatment sites in pediatric patients) (Emphasis added.)
- Adaptive support in response to assessed patient need (for example, postural support, orthopedic appliance, tabletop chairs)
- Helmets
- Restraint use for behavioral health care reasons (to which he restraint standards in this manual for behavioral health care apply)
- Forensic and correction restrictions used for security”
[CAMH Refreshed Core, January 2008, pages PC-25-26]
Behavioral Health Care Restraint and Seclusion
In the section of the CAMH addressing behavioral health care restraint and seclusion, standard PC.12.70, states, “A licensed independent practitioner* orders the use of restraint or seclusion.
*This standard is not to be construed to limit the authority of a licensed independent practitioner to delegate tasks to physician assistants and advanced practice nurses to the extent recognized under state law or a state's regulatory mechanism and allowed by the organization."
[CAMH Refreshed Core, January 2008, page PC-35]
Standard PC.12.90 states, “A licensed independent practitioner sees and evaluates the patient in person.”
The Elements of Performance for PC.12.90, state, “In hospitals that use accreditation for Medicare deemed status purposes, a physician or other licensed independent practitioner must evaluate the patient within one hour of the initiation of restraint or seclusion. A registered nurse or physician assistant may evaluate the patient within one hour of the initiation of restraint or seclusion, provided that they are trained and that thy consult with the attending physician or other licensed independent practitioner as soon as possible after their evaluation, as required by the Centers for Medicare and Medicaid Service’s (CMS’s) Final Rule for Patient Rights, effective January 8, 2007.
[CAMH Refreshed Core, January 2008, pages PC-35-36]
Last Revised: 1/28/08
