CMS SOM App. N, Tag N0144

(1) Be limited to no longer than the duration of the emergency safety situation; and

(2) Under no circumstances exceed 4 hours for residents ages 18 to 21; 2 hours for

residents ages 9 to 17; or 1 hour for residents under age 9.

Interpretive Guidelines§ 483.358(e)

A restraint or seclusion must be used only until the emergency safety situation has ceased

and the resident’s safety and the safety of others can be ensured, even if the restraint or

seclusion order has not expired. The time frames specified in these requirements are

maximums per age group. The ordering practitioner has the discretion to decide that the

order be written for a shorter period of time. Throughout the restraint or seclusion

period staff should be assessing, monitoring, and re-evaluating the resident so that he or

she is released from the restraint or seclusion at the earliest possible time.

If restraint or seclusion is discontinued prior to the expiration of the original order, a

new order must be obtained prior to reinitiating seclusion or reapplying restraints. At

the point in which a new order for restraint or seclusion has been obtained, all

requirements for monitoring and documentation begin as with all new orders.

Specifically, after a resident has been removed from restraint or seclusion for any

amount of time, the next incident of restraint or seclusion may not be considered a

continuation of the previous restraint or seclusion order.