CMS SOM App. A, Tag A-0178

destructive behavior that jeopardizes the immediate physical safety of the patient, a staff member,

or others, the patient must be seen face-to-face within 1 hour after the initiation of the

intervention --

(i) By a –

(A) Physician or other licensed practitioner; or

(B) Registered nurse who has been trained in accordance with the requirements

specified in paragraph (f) of this section.

Interpretive Guidelines §482.13(e)(12)(i)

When restraint or seclusion is used to manage violent or self-destructive behavior, a physician or other

LP, or a registered nurse (RN) trained in accordance with the requirements specified under §482.13(f),

must see the patient face-to-face within 1-hour after the initiation of the intervention. This requirement

also applies when a drug or medication is used as a restraint to manage violent or self-destructive

behavior.

The 1-hour face-to-face patient evaluation must be conducted in person by a physician or other LP, or

trained RN. A telephone call or telemedicine methodology is not permitted.

If a patient’s violent or self-destructive behavior resolves and the restraint or seclusion intervention is

discontinued before the practitioner arrives to perform the 1-hour face-to-face evaluation, the

practitioner is still required to see the patient face-to-face and conduct the evaluation within 1 hour after

the initiation of this intervention. The fact that the patient’s behavior warranted the use of a restraint or

seclusion indicates a serious medical or psychological need for prompt evaluation of the patient behavior

that led to the intervention. The evaluation would also determine whether there is a continued need for

the intervention, factors that may have contributed to the violent or self-destructive behavior, and

whether the intervention was appropriate to address the violent or self-destructive behavior.

EXCEPTION: Repetitive self-mutilating behaviors – see interpretive guidance for §482.13(e)(6).

Survey Procedures §482.13(e)(12)(i)

• Review the hospital policy regarding the 1-hour face-to-face evaluation.

• What categories of practitioners does the hospital policy authorize to conduct the 1-hour face-to-face evaluation?

• Interview staff to determine if practice is consistent with hospital policy.