The healthcare field has become much more complex in recent years, writes American healthcare security man Kevin Mulcahy.
Laws, rules, and regulations are always evolving and in order to thrive in this environment, you must be prepared. The purpose of this article is to help educate hospital staff of DNV accreditation requirements as they relate to restraint and seclusion of psychiatric patients. An audit from DNV inspectors has the potential to be stressful if staff is not prepared. Thorough documentation and training records along with well-trained staff will ensure that DNV has nothing but good things to say about your hospital. Staff training should always be current and documentation should be complete and up to date. As far as DNV is concerned, if documentation doesn’t exist, training didn’t happen.
Although DNV does not indicate how often staff must be trained in the safe application of restraints, many hospitals complete refresher courses once per year. This recertification must be taught by a physician or licensed independent practitioner with the knowledge, skills, and experience to competently train clinical staff as well as hospital security officers and any other staff that would likely be called to assist with the restraint of a patient. The hospital restraint/seclusion policy should be reviewed at the time of this training. A copy of the completed training record should be given to the human resources manager to be placed in each trained employee’s personnel file. During a DNV inspection, staff will be asked about the restraint and seclusion policy. It is not necessary for staff to recite the policy word for word. It is acceptable to reference the hospital policy from an easy to find location. A binder of relevant policies should be kept in any department that may experience putting a patient in restraints. A binder of this policy as well as all security policies should also be kept in the hospital security office. It is also helpful to have a file containing the training records of each security officer in an easy to access location.
An often overlooked group of staff that is responsible for the ordering of restraints/seclusion is doctors. According to the National Integrated Accreditation for Healthcare Organizations accreditation requirements, “At a minimum, physicians and other LIP’s authorized to order restraint or seclusion by hospital policy in accordance with State law must have a working knowledge of the hospital policy regarding the use of restraint or seclusion. Physician and other LIP training requirements must be specified in hospital policy. Individuals providing staff training must be qualified as evidenced by education, training, and experience in techniques used to address patients’ behaviors. The hospital must document in the staff personnel records that the training and demonstration of competency were successfully complete.”
DNV standards strive for constant improvement and meeting the minimum standards is not in the spirit of the DNV audit process. DNV auditors request that doctors participate in restraint training and are able to properly apply restraints as well as explain hospital policy as it applies to restraints and seclusion. Involvement in training of de-escalation techniques and behavior modification is also encouraged.
Crisis Prevention Institute (CPI) or similar training is necessary before staff is able to participate in the restraint process. DNV policy states that staff must be familiar with and use de-escalation techniques and non-physical intervention skills before utilizing restraint or seclusion whenever possible. While many hospitals require CPI training annually, all staff that could be expected to assist in the restraint process should maintain CPI certification. This includes physicians, nurses, and maintenance staff if they may be expected to assist.
Thorough documentation is necessary for a positive DNV review. Medical staff must document in a patient’s medical record all steps taken to prevent the use of seclusion and/or restraints. Statements such as “I calmly explained the IEA process to the patient as he began shouting that the process was taking too long. I offered him several magazines to help pass the time. The patient then threw a chair at me and began banging his head on the wall. The physician ordered the patient to be put in restraints for the safety of the patient and those around him”. Security must document in the patient’s standby report all steps they took to keep the situation under control to prevent the use of restraints. The complex nature of the healthcare field dictates the need for extensive training and documentation. Thorough training ensures that staff will be in compliance and be able to confidently answer any question posed by DNV inspectors. Proper record keeping will show inspectors that your hospital staff takes rules and regulations seriously. Exceeding the expectations of DNV will ensure compliance now and in the future.
About the author
Kevin Mulcahy is a Security Sergeant for Lakes Region General Healthcare in New Hampshire. He holds a BS in Business Management and is currently pursuing an MBA in Hospital Administration at Plymouth State University. He is certified in both hospital security and hospital safety. He has experience in loss prevention, risk management, and law enforcement. He is a member of the US-based International Association for Healthcare Security and Safety (IAHSS).
