The Greeley Company
December 14, 2018 2 Min Read

Common Survey Challenges: Restraint Orders

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Question: You said that orders for non-violent restraints no longer need to be renewed every 24 hours?

Restraint OrdersOn December 6, 2018 The Greeley Company held its annual “Survey Hot Spots” national webinar. Feel free to view our free “Hot Spots” webinar in case you missed the live session.

Among the questions raised during the webinar was a question about restraint renewal orders.

Restraint remains the #1 topic cited by CMS during for cause validation surveys. Greeley will be offering a Premium webinar that covers restraint in the near future.

The attendee’s question about restraint orders during the “Hot Spots” session and our answer are below.

Return to Hot Spots Q and A post.

[One of the topics covered in the wide-ranging “Hot Spots” webinar was common myths related to restraint, among them the mistaken belief that restraint orders had to be renewed every 24 hours, which stimulate the following question and response.]

Question: You said that orders for non-violent restraints no longer need to be renewed every 24 hours?

  • Answer: When the CMS interpretive guidelines for restraint were rewritten more than a decade ago the requirement for a 24-hour renewal orders for “non-violent” restraint was removed. The Joint Commission followed suit for “deemed” hospitals a few years later.

If you don’t read the CMS requirements carefully, however, you might get the wrong impression.

The CMS restraint requirements are segmented into two parts: 1. general requirements for restraint and 2. additional requirements for restraint that is used for the “management of violent or aggressive behavior that places the patient or others at imminent risk of harm” (which some call “violent” or “behavioral” restraint).

The 24-hour “start again” requirement pertains only to the latter situation (“violent” restraint). This is somewhat confusing because “violent” restraint orders must also be renewed every 4 hours (adults) within each 24-hour violent restraint “episode.”

We recommend that orders for non-violent (pulling-at-lines) restraint be either renewed each calendar day (vs. each 24 hours) or expire based on criteria established in the initial order (i.e. a criteria-based order). There are pros and cons to both approaches, but either fully complies with CMS, accreditation and common state requirements.

Our upcoming Premium online education program about restraint will provide a model policy, an detailed analysis of the actual requirements (CMS, Joint Commission, other accreditors, and selected states), an editable slide deck for staff training, tools to help front-line personnel distinguish between potentially confusing things (restraint vs. not restraint, violent vs. non-violent, seclusion vs. non-seclusion). It will also deal with the often misunderstood topic of “chemical restraint”.

The Greeley Company team looks forward to helping you solve these difficult problems in the months and years to come. For more information about how Greeley can help accelerate solving your challenges with practical solutions, you may contact us at 1.888.749.3054, email us at or complete the form below to start the conversation.

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