CMS SOM App. N, Tag N0142

facility to order restraint or seclusion must order the least restrictive emergency safety

intervention that is most likely to be effective in resolving the emergency safety

situation based on consultation with staff.

Interpretive Guidelines§ 483.358(c)

The restraint or seclusion used must be appropriate for both the resident and the

situation. The treatment plan should address any contraindications or inappropriate

interventions for the resident. A medication that is not being used as a standard

treatment for the resident’s medical or psychiatric condition that results in controlling

the resident’s behavior and/or in restricting his or her freedom of movement is

considered a restraint.

Example: Staff use of physical restraint hold for a resident who is verbally abusive

and/or escalating without having utilized other non-physical de-escalation techniques

would be considered as not appropriate or not least restrictive. Verbal de-escalation

techniques and decrease in physical environmental stimuli would be considered least

restrictive. Use of any physical intervention would be considered counter therapeutic,

and potentially traumatic, for victims of physical or sexual abuse.

The residents’ treatment plan should indicate the least restrictive interventions to help

the resident and treatment staff in the case of emergency situations where an

unanticipated behavior requires immediate protection of the individual or others.

Documentation in the residents medical record should detail the less restrictive measures

utilized prior to the application of the restraint or seclusion.

Staff should document interventions that have been attempted prior to implementing

seclusion or restraint. The effectiveness or ineffectiveness of interventions should be

evaluated and incorporated into the resident’s treatment plan and these should also be

used as a basis for planning for future interventions.