Are you a behavioral health organization that uses restraint or physical holding as interventions? Does TJC survey your organization under the Behavioral Health Care manual? If so, make sure you understand the TJC restraint definition and the distinction between restraint and physical holding.
TJC recently clarified this in the FAQ they published on 2/10/20: Physical Hold vs Restraint or Seclusion.
TJC Restraint and Physical Holding Standards
TJC’s Behavioral Health manual includes standards for both restraint and physical holding of children/youth. These standards are in the Care, Treatment, and Services chapter. (By comparison, it’s important to note that the Hospital manual does not have standards for the physical holding of children/youth.)
TJC defines physical holding of children/youth as “A method of restraint in which a child’s or youth’s freedom of movement or normal access to his or her body is restricted by means of staff physically holding the child or youth for safety reasons.”
TJC defines restraint as “Any method of restricting an individual’s freedom of movement, including seclusion, physical activity, or normal access to hs or her body that:
- is not a usual and customary part of a medical diagnostic or treatment procedure to which the individual or his/her legal representative has consented
- is not indicated to treat the individual’s medical condition or symptoms, or
- does not promote the individual’s independent functioning.”
Use of Restraint vs. Physical Holding
For adults, TJC considers any physical holding a restraint (as does CMS.) Thus, there are no separate standards in the Behavioral Health manual for physical holding of adults. If your organization uses physical holding of adults, TJC applies the restraint/seclusion standards.
For children and youth, physical holding is a separate intervention from restraint. In the Behavioral Health manual, there are separate standards for the physical holding of children/youth. However, if your organization also uses restraint of children/youth (in addition to physical holding) TJC applies the restraint standards.
Age Groups for Physical Holding
In terms of physical holding, TJC defines “youth” as: “A person 13 years of age or older who has not reached age of majority, or as identified by law and regulation.”
TJC defines “child” as: “A person between 0 and 12 years of age, or as determined by applicable law and regulation.”
Tip: When writing your policy on physical holding, it’s important to include clear age definitions.
TJC Restraint and Seclusion Tracer
For any organization that uses restraint, seclusion, or physical holding, TJC typically conducts a tracer on a patient who’s had this intervention. They review the following key areas: First, policies and procedures; Second, staff training and competency assessment on de-escalation; Third, staff training and competency assessment on use of restraint, physical holding, and seclusion; and lastly, documentation of these interventions in the clinical record with evidence of meeting all requirements for orders, monitoring, and release.
In addition, surveyors will also carefully review that you’ve updated the treatment plan to address how use of restraint, seclusion, or physical holding can be avoided in the future.
For more details on the program-specific tracer on restraint/seclusion, see the TJC Survey Activity Guide on your Joint Commission Connect site.
Requirements for Improvement in TJC survey reports are still common for restraint, physical holding, and seclusion. Thus, we recommend you carefully review your practices to ensure you’re in compliance with TJC requirements.
In addition, conduct thorough audits of any occurrence of restraint, seclusion, or physical holding to make sure the clinical documentation is in order. Report these results into your Performance Improvement program. Above all, take action as needed to improve your practices and ensure patient safety.
TJC Restraint FAQs
TJC has some additional, helpful FAQs on restraint, seclusion, and physical holding:
- Restraint and Seclusion – Telemedicine
- Restraint or Seclusion – Role of Residents Enrolled in Graduate Medical Education Programs
Barrins & Associates Resources
When we conduct our Mock Surveys and Continuous Readiness Consultations, we always include a tracer on restraint/seclusion and physical holding. We also share our resources on best practices and survey readiness strategies. As always, we’ll continue to keep you posted on TJC and CMS survey readiness and best solutions for ongoing compliance.