US · guidance
CMS SOM App. N, Tag N0131
§483.356(a)(4) Restraint and seclusion must not be used simultaneously
Interpretive Guidelines§ 483.356(a)(4)
The facility must not utilize restraint, including drugs/medications used as restraint at the
same time as utilizing seclusion.
There may be isolated instances where both physical and psychopharmacological
restraints are required during one emergency safety situation. In addition, the risk(s)
associated with any drug/medication used as a restraint must be weighed against the type
and severity of the behavior the resident is exhibiting. The resident record must include
documentation to explain why the first restraint was insufficient and the second restraint
was added.
If restraint is necessary as a means of safely transporting the resident to seclusion, a
separate order is not required. However, the initial order for the seclusion must include
the physical transport restraint and be consistent with the requirements for
restraint/seclusion orders.
History
Rev. 131; Issued: 01-16-15, Effective: 01-16-15, Implementation: 01-16-15
Provenance
- Source
- cms.gov
- Retrieved
- 2026-07-22
- Edition
- som-2026-07-22
- Content hash
cd4d77bf668bfa529edf1b89d2f8c6f2faaf7b55c1ab92d0f394393b13518cac
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