Effective Jan. 1, 2025, new and revised requirements will apply to behavioral health care and human services (BHC) organizations that use restraint and/or seclusion. The changes include revising the definition of restraint; reducing redundancies; streamlining processes; and removing requirements for physical holding of a child or youth and incorporating this concept into the requirements for restraint and seclusion because physical holding that restricts freedom of movement is a type of restraint.
Physical holding restraints can be as dangerous as other types of restraint and should be held to the same requirements, as evidenced by a study that examined data collected over 26 years regarding restraint fatalities among children and adolescents in the United States. The study confirms deaths from physical holding restraints (that is, without any devices). In this study, 63 of 79 reported deaths were from physical holding without mechanical devices.
Recommendations to improve safety when using any restraints include implementing and following robust organizational processes (Nunno MA, et al. A 26-year study of restraint fatalities among children and adolescents in the United States: A failure of organization structures and processes. Child Youth Care Forum. 2022;51(3):661–680. Accessed Jun 5, 2024). As part of these processes, well-established clinical practice and many federal and state regulations require the oversight of licensed practitioners who order restraints and evaluate individuals who are in restraint and seclusion.
The revised definition of restraint in the Glossary (GL) of the Comprehensive Accreditation Manual for Behavioral Health Care and Human Services (CAMBHC) clarifies what is and is not a restraint as follows:
- restraint Restraint is any method (chemical or physical) of restricting the freedom of movement of an individual served to manage their behavior. This includes any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of an individual to move their arms, legs, body, or head freely. It also includes any drug or medication when it is used as a restriction to manage the individual’s behavior or to restrict their freedom of movement and is not a standard treatment or dosage for their condition.
Interventions that do not restrict movement (such as a light grasp that the individual could easily remove or escape from) do not meet the definition of restraint. Examples of this include the following:
- Briefly holding an individual to calm or comfort them
- Physically assisting someone to complete a task
- Escorting or guiding someone away from an area or situation
- Separating individuals to break up a fight
- Physical interventions to prevent imminent danger (stopping an individual from running into traffic, tripping, or falling)
The new and revised requirements will be posted on the Prepublication Standards page of The Joint Commission’s website and will publish online in the fall 2024 E-dition® update to CAMBHC. For those who purchase them, the fall 2024 update service and the 2025 hard-copy and PDF versions of CAMBHC will include these requirements.
For more information, please contact The Joint Commission’s Standards and Survey Methods.
New and revised workplace violence prevention requirements for Joint Commission accredited home care organizations are effective Jan. 1, 2025. Workplace violence poses a significant occupational hazard for home care workers. However, the prevalence may be underestimated due to underreporting, as incidents are often perceived as minor. Inadequate training also contributes to the problem.
The Joint Commission previously implemented accreditation requirements on workplace violence prevention in its behavioral health care and human services, critical access hospital, and hospital programs. To assess the suitability of extending these requirements to home care settings, The Joint Commission:
- Conducted a literature review.
- Gathered feedback from current accredited organizations.
- Convened a technical advisory panel of representatives from various public and private organizations as well as Joint Commission accredited home care organizations.
The new and revised requirements provide a framework to guide home care organizations across various settings to develop effective workplace violence prevention strategies. The requirements address the following:
- Defining workplace violence, including a formal definition added to the Glossary
- Outlining leadership oversight
- Developing policies and procedures to prevent workplace violence
- Reporting systems, data collection, and analysis
- Implementing post-incident strategies
- Providing training and education to decrease workplace violence
The new and revised requirements will be posted on the Prepublication Standards page of The Joint Commission’s website and will publish online in the fall 2024 E-dition® update to the home care manual. For those who purchase them, the 2025 hard-copy and PDF versions of the manual will include the new and revised standards.
For more information, please contact The Joint Commission’s Global Accreditation and Certification Product Development via the Standards Online Submission Form.
NQF is seeking public comment as part of the consensus-based process to update the Serious Reportable Events (SRE) list. Specifically, NQF is seeking public review and comment on the 66 candidate SREs that are to be considered for inclusion on the 2024 SRE list, including 29 existing events from the 2011 SRE report and 37 candidate events submitted in response to NQF’s call for public input on candidate patient safety events that meet the updated inclusion criteria.
The public comment period will be open through Aug. 2, 2024, at 6 pm ET and will include the opportunity to comment on the candidate events and provide input to ensure the 2024 SRE list is comprehensive and reflective of today’s healthcare. See Serious Reportable Events In Healthcare – 2011 Update: A Consensus Report for information regarding the current SRE list.
Please contact the NQF team at patientsafety@qualityforum.org if you have any questions.