Magazine article Clinical Psychiatry News

Restraint on Restraints. (Guest Editorial)

Magazine article Clinical Psychiatry News

Restraint on Restraints. (Guest Editorial)

Article excerpt

It's been more than 2 years since the Centers for Medicare and Medicaid Services promulgated new guidelines on the use of restraints in psychiatric hospitals. The intent of these guidelines--the reduction in the use of restraints--is laudable, but in practice they're causing administrative and clinical problems that have had the unintended consequence of undermining patient care.

First, let's look at the administrative problems. The regulations impose financial hardships, especially on hospitals in rural settings. This comes from the requirement for a physician to evaluate a restrained patient every few hours and from the need to increase staffing to support the new regulations and to maintain CMS certification. Financial resources used for these purposes must be taken from other aspects of patient care.

The enhanced documentation requirements often lead, through the use of Freedom of Information legislation and other means, to sensationalized media accounts of unusual or dramatic cases that do not represent the vast majority of patients who are placed under restraint. Politicians use these reports for their own ends. The result is often an overreaction from people attempting to exert their influence on hospitals.

The patients' privacy rights are violated when more details end up being released to the media. The patients' right to adequate treatment is compromised when staff members have to devote more of their time and attention to administering restraint regulations. And the patients' right to simple peace and quiet is violated when restraints cannot be used as much as necessary. The unit is inevitably subjected to more commotion, more disturbances, and more chaos. The staff can go to another place in the building and they get to go home at night, but the patients must endure the chaos. These regulations are intended to enhance patients' rights, but in practice they can have exactly the opposite effect.

In terms of clinical care, some aspects of the regulations make it harder for us to apply common sense. …

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