A-0154
§482.13(e) Standard: Restraint or seclusion.
All patients have the right to be
free from physical or mental abuse, and corporal punishment. All patients have the
right to be free from restraint or seclusion, of any form, imposed as a means of
coercion, discipline, convenience, or retaliation by staff. Restraint or seclusion may
only be imposed to ensure the immediate physical safety of the patient, a staff member,
or others and must be discontinued at the earliest possible time.
Interpretive Guidelines §482.13(e)
:
The intent of this standard is to identify patients’ basic rights, ensure patient safety, and
eliminate the inappropriate use of restraint or seclusion. Each patient has the right to
receive care in a safe setting. The safety of the patient, staff, or others is the basis for
initiating and discontinuing the use of restraint or seclusion. Each patient has the right
to be free from all forms of abuse and corporal punishment. Each patient has the right to
be free from restraint or seclusion, of any form, imposed as a means of coercion,
discipline, convenience, or retaliation by staff. Restraint or seclusion may not be used
unless the use of restraint or seclusion is necessary to ensure the immediate physical
safety of the patient, a staff member, or others. The use of restraint or seclusion must be
discontinued as soon as possible based on an individualized patient assessment and re-
evaluation. A violation of any of these patients’ rights constitutes an inappropriate use
of restraint or seclusion and would be subject to a condition level deficiency.
The patient protections contained in this standard apply to all hospital patients when the
use of restraint or seclusion becomes necessary, regardless of patient location. The
requirements contained in this standard are not specific to any treatment setting within
the hospital. They are not targeted only to patients on psychiatric units or those with
behavioral/mental health care needs. Instead, the requirements are specific to the
patient behavior that the restraint or seclusion intervention is being used to address.
In summary, these restraint and seclusion regulations apply to:
• all hospitals (acute care, long-term care, psychiatric, children's, and cancer);
• all locations within the hospital (including medical/surgical units, critical care
units, forensic units, emergency department, psychiatric units, etc.); and
• all hospital patients, regardless of age, who are restrained or secluded
(including both inpatients and outpatients).
The decision to use a restraint or seclusion is not driven by diagnosis, but by a
comprehensive individual patient assessment. For a given patient at a particular point in
time, this comprehensive individualized patient assessment is used to determine whether
the use of less restrictive measures poses a greater risk than the risk of using a restraint
or seclusion. The comprehensive assessment should include a physical assessment to
identify medical problems that may be causing behavior changes in the patient. For
example, temperature elevations, hypoxia, hypoglycemia, electrolyte imbalances, drug
interactions, and drug side effects may cause confusion, agitation, and combative
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