Can residents or house staff write orders and/or evaluate a patient for restraint or seclusion for behavioral health reasons?  

Joint Commission standards require that a licensed independent practitioner order restraint or seclusion when applied for behavioral health reasons, and conduct an in-person (face-to-face) evaluation of a patient in restraint or seclusion. Under the following four conditions a physician in a graduate medical education program (i.e., residency) may perform these activities. These activities, as all other patient care activities performed by the participants in graduate medical education programs, are to be appropriately supervised. Four requirements must be met for a resident to order restraint or seclusion for behavioral health reasons, or conduct the required face-to-face evaluation of a patient in restraint or seclusion:

• State law permits residents to perform these two activities under the auspices of a graduate medical education program.
• The graduate medical education program has provided relevant education and training for the resident in performing these two activities. [Graduate medical education programs accredited by the Accreditation Council on Graduate Medical Education would be expected to be in compliance with this requirement; the organization should be able to demonstrate compliance with any residency review committee citations related to this requirement.]
• In the judgment of the graduate medical education program, the resident is able to competently perform these two activities.
• The health care organization in which the resident provides patient care permits residents to perform these two activities.

NOTE: A medical student has no legal status as a provider of health care services, therefore, would not be qualified to conduct an in-person evaluation of a patient in restraints or seclusion.