CMS SOM App. A, Tag A-0186

of the following:]

§482.13(e)(16)(iii) - Alternatives or other less restrictive interventions attempted (as applicable).

Interpretive Guidelines §482.13(e)(16)(iii)

The use of restraint or seclusion must be selected only when less restrictive measures have been judged

to be ineffective to protect the patient or others from harm. It is not always appropriate for less

restrictive alternatives to be attempted prior to the use of restraint or seclusion. When a patient’s

behavior presents an immediate and serious danger to his- or herself, or others, immediate action is

needed. For example, when a patient physically attacks someone, immediate action is needed. While

staff should be mindful of using the least intrusive intervention, it is critical that the intervention selected

be effective in protecting the patient or others from harm.

Survey Procedures §482.13(e)(16)(iii

):

• Does the patient’s medical record document any alternatives or less restrictive interventions

attempted by staff, if appropriate?

• What was the effect of less restrictive interventions, if attempted by staff?

• Were the interventions selected appropriate to the targeted patient behaviors?

• When an immediate and serious danger to the patient or others occurred, was the more restrictive

intervention(s) effective? Could a less restrictive intervention have been used to ensure the

safety of the patient, staff or others?