Joint Commission Removes “Licensed Independent Practitioner” Term from Restraint and Seclusion Standards

New Term Removes Uncertainty

March 6, 2020

Effective March 15, Joint Commission is removing the term “licensed independent practitioner” (LIP) from hospital restraint and seclusion standards.  Joint Commission made the change to comply with Medicare and Medicaid regulations updated in September 2019. As an organization “deemed” to qualify hospitals for Medicare and Medicaid reimbursement, Joint Commission must ensure that its standards align with Medicare and Medicaid regulations.

The changes, released in a prepublication version on March 4, 2020, are shown below. New standards language is in bold type.

PC.03.05.05

The hospital initiates restraint or seclusion based on an individual order.

Element(s) of Performance for PC.03.05.05

1. A physician, clinical psychologist, 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) (refer to the Glossary).
2. A physician or other authorized licensed practitioner responsible for the patient’s care orders the use of restraint or seclusion in accordance with hospital policy and law and regulation.
3. Unless state law is more restrictive, every 24 hours, a physician, clinical psychologist, 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.
   Note: The definition of “physician” is the same as that used by the Centers for Medicare & Medicaid Services (CMS) (refer to the Glossary).
4. Unless state law is more restrictive, every 24 hours, a physician or other authorized licensed practitioner responsible for the patient’s 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.

Use of the new term, “licensed practitioner,” removes any uncertainty that PAs are qualified to order patient restraint and seclusion. The need to restrain or seclude patients usually arises in urgent situations where a patient is a risk to themself or others. It is to the benefit of patients and staff that PAs now clearly can issue needed orders when they are the first available provider.

View the prepublication standards.