Show restraint.

New restraint rules for hospitals similar to nursing homes'

HOSPITALS MAY SOON BE TAKING MORE CUES from nursing homes that have pledged to be restraint-free, say experts familiar with HCFA's new regulations regarding the use of restraints and seclusion in long-term, rehabilitation, and other hospitals. The rules, issued as an interim final rule in the July 2 Federal Register, also apply to acute care, children's, and psychiatric hospitals.

As of August 2, all hospitals that receive Medicare and Medicaid funds must comply with the regulations, which are similar to those in effect for nursing homes.

Hospital personnel faced with the new rules have already visited the 514-bed Jewish Home and Hospital in Manhattan, according to Richard Neufeld, MD, vice president of medical services for the Jewish Home. Hospitals will need to develop new techniques and methods and use safe interventions, such as beds that are low to the ground, in order to limit their use of restraints and seclusion, he says.

HCFA's rules governing the use of restraints and seclusion state that neither are to be used unless "clinically necessary." The regulations also state: "The patient has the right to be free from the use of seclusion or restraint, of any form, as a means of coercion, discipline, convenience or retaliation by staff."

Restraints are permitted for acute medical and surgical care, but seclusion is not. Both may be used for behavioral management. The rules establish time limits for their use: four hours for adults, two hours for those aged nine to seventeen, and one hour for children under nine years old. Restraints and seclusion may be ordered by any licensed practitioner given such authority by state law or a hospital, but such an order must be reviewed as soon as possible by the attending physicians if he or she did not write the order.