CMS 2019 Hospital Restraint & CMS CAH New Swing Bed Requirements and Changes

Live Workshop | Sue Dill Calloway | From: Dec 05, 2019 - To: Dec 31, 2019

This webinar is a pack of two webinars:-

  • CMS 2019 Hospital Restraint and Seclusion: Navigating the Most Problematic CMS Standards and Proposed Changes

Did you know that the number one area of deficiencies in the CMS CoP is regarding restraints? CMS issued a memo summarizing all of the deficiencies against hospitals which is updated quarterly. This program will discuss the most problematic standards in the restraint section.  If a CMS surveyor showed up at your hospital tomorrow would you be prepared? Does your staff understand all 50 pages of the CMS interpretive guidelines? This program also discusses the proposed changes to restraint published in the Hospital Improvement Act.

This program will discuss the requirements for an internal log and what must be in the log for patients who die in one or two soft wrist restraints. It will include what must be documented in the medical record also. It will also discuss the reporting requirements for patients who die in restraints and within 24 hours of being in a restraint.

This program will simplify and take the mystery out of that 50-page restraint and seclusion interpretive guidelines. It will provide a crosswalk to the Joint Commission standards. Avoid the restraint nightmare now and let us take the mystery out of these confusing regulations by attending this program. 

    Areas Covered:-

    • Right to be free from restraint 
    • Number of deficiencies
    • Providing a copy of right to patients
    • Restraint protocols
    • Proposed changes in the hospital improvement act
      • PA to order and change from LIP to LP
    • CMS deficiency reports
    • CMS changes effectively to internal log and soft wrist restraints
    • Most current manual
    • Medical restraints
    • Behavioral health restraints 
    • Violent and self-destructive behavior
    • Definition of restraint and seclusion
    • Manual holds of patients 
    • Leadership responsibilities
    • Two soft wrist restraints, internal log, and documentation
    • Culture of safety
    • Drugs used as a restraint
    • Standard treatment
    • Learning from each other
    • Restraints do not include
    • Side rails, forensic restraints, freedom splints, immobilizers
    • Assessment
    • Need order ASAP
    • Order from LIP and notification of attending physician ASAP
    • Documentation requirements
    • Least restrictive requirements
    • Alternatives 
    • RNs and One hour face to face assessment
    • Training for RN doing one hour face to face assessment
    • New training requirements
    • New death reporting requirements
    • Ending at the earliest time
    • Revisions to the plan of care
    • PI requirements
    • Time-limited orders
    • Renewing orders 
    • Staff education
    • First aid training required
    • Stricter state laws
    • Monitoring of patient in R/S
    • Joint Commission Hospital Restraint standards and differences from CMS

    Why Should You Attend?

    • Define the CMS restraint requirement of what a hospital must document in the internal log if a patient dies within 24 hours with having two soft wrist restraints on
    • Recall that CMS requires that all physicians and others who order restraints must be educated on the hospital policy
    • Describe that CMS has restraint education requirements for staff.
    • Discuss that CMS has specific things that need to be documented in the medical record for the one hour face to face evaluation on patients who are violent and or self-destructive

    Who Will Benefit?

    All nurses with direct patient care, compliance officer, chief nursing officer,  chief of medical staff,  COO, Nurse Educator,  ED nurses, ED physicians,  Medical staff coordinator, risk manager, patient safety officer, senior leadership, hospital legal counsel, Risk Manager, Chief Risk Officer, PI director, Joint Commission coordinator, nurse managers, quality director, chief medical officer, security guards, compliance officer, chief risk officer, accreditation and regulation staff and others responsible for compliance with hospital regulations and anyone involved in the restraint or seclusion of patients. Persons responsible for rewriting the hospital policies and medical staff bylaws should attend. This also includes staff that removes and apply them as part of their care such as radiology techs, ultrasound technologists, transport staff, and others.


    • CMS CAH New Swing Bed Requirements and Changes

    Every hospital should be prepared in case a surveyor shows up at your door tomorrow. This webinar will focus on the protocol changes and the swing bed changes that were promulgated by CMS on October 12, 2018. In fact, CMS completely rewrote all of the swing bed regulations.  The swing bed interpretive guidelines and survey procedures are now under Appendix PP.  Many CAHs are not aware of these changes.

    Hospitals have seen a significant increase in survey activity by CMS along with an increased number of deficiencies. Common deficiencies and how to avoid them will be discussed. Information on how to locate the CAH manual and other resources will be discussed.

    Session Agenda:-

    Changes to the CAH Manual and Introduction to CAH CoPs

    • How to Locate the CAH Manual
    • Introduction
    • CMS Surveyor training material for CAHs
    • Important CMS Memos for CAHs
    • Notice of survey
    • Revised survey protocol
    • Review of telemedicine contract     

    Special Requirements for CAH Providers of Long-Term Care Services (Swing beds)

    • Swing bed regulations were rewritten October 12, 2018
    • Interpretive guidelines and survey procedure under Appendix PP
    • Eligibility
    • Payment
    • Healthcare literacy
    • SNF Services
    • Resident Rights
    • Exercise of Rights
    • Notice of Rights and Services
    • Free Choice
    • Privacy and Confidentiality
    • Work
    • Mail
    • Access and Visitation Rights
    • Personal Property
    • Married Couples
    • Admission, Transfer and Discharge Rights
    • Transfer and Discharge
    • Payment of care
    • Content of notice
    • Resident Behavior and Facility Practices
    • Restraints, Abuse
    • Staff Treatment of Residents
    • Hiring of employees
    • Patient Activities
    • Social Services
    • Dental requirements changes
    • Resident Assessment
    • Comprehensive Care Plans
    • PASARR or RAI
    • Discharge Summary
    • Nutrition
    • Provision of Services
    • Websites for CAH
    • CAH resources


    • Discuss that CMS made some recent changes to the protocol process
    • Recall that CMS has rewritten the entire section on swing beds
    • Describe what is required by CMS to be in the resident assessment which is done to do the care plan
    • Recall the CMS requirements on patient activities of swing bed patients

    Who Should Attend?

    Basically anyone who is responsible for taking care of swing bed patients in a CAH or for implementing the CMS swing bed requirements. This includes the following:-

    • CEOs
    • COOs
    • CFOs
    • Nurse Executives
    • Accreditation and Regulation Director
    • Nurse Managers
    • Pharmacists
    • Quality Managers
    • Risk Managers
    • Healthcare Attorneys
    • Health Information Management Personnel
    • Social Workers
    • Dieticians
    • Health Information Management
    • Nurses
    • Nurse Educators
    • Nursing Supervisors
    • Patient Safety Officer
    • Director of Rehab (OT, PT, speech pathology, and audiology)
    • Dietician
    • Director of Health Information Management
    • Infection Preventionist
    • Activities Director of Swing Bed patients
    • Compliance Officers

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