Magellan Position Statement on the Use of Seclusion and Restraints
The use of seclusion and restraints, both physical and chemical, is a last resort for maintaining the safety of patients, visitors and treatment personnel, and should be utilized only when clearly indicated by a policy detailing specific criteria. Such measures are to be implemented when medically necessary, in the least restrictive manner by personnel specifically trained in safe and appropriate techniques, and discontinued at the earliest possible time. Seclusion and restraints are not to be used for disciplinary purposes or as a standing order. When there is a need to utilize seclusion or restraints, facilities will treat patients with the utmost dignity and respect and protect them from humiliation. Facilities must have written policies that include last resort indications for the use of seclusion or restraints, and specific monitoring parameters during the period of seclusion or restraint, such as the frequent monitoring of neurological condition, vital signs and placement of restraint.
Annually Reviewed Policy
Magellan expects each of its contracted facilities to have an annually revised policy or policies that include general and patient-specific prevention initiatives for reducing the use of seclusion and restraints, such as a policy governing the structuring of activities for the entire day for patients, a factor known to decrease episodes of violence. Magellan also expects contracted facilities to have an annually revised policy that includes a mission statement and values for the safe and proper use of seclusion and restraints. These policies are to be designed to foster appropriate staff knowledge, expertise, and skills concerning the use of seclusion and restraints, and prescribe multiple measures to avoid inappropriate use, e.g. staff debriefing and education following each use of seclusion and restraints.
Only in Emergencies When Danger is Imminent
Magellan supports the Centers for Medicare and Medicaid Services’ manual
on day-to-day operating instructions, policies, and procedures
based on statutes and regulations, guidelines, models, and directives
which include a section on the use of seclusion and restraints
entitled (CMS) Standard:
Seclusion and Restraint for Behavior Management 
.
(Standard 482.13(e) & (f)). It states, “A restraint
or seclusion for behavior management is used only as an emergency
measure and is reserve for those occasions when severely aggressive,
combative, or destructive behavior places the patient or others
in imminent danger.” It also includes recommendations that
individual patient treatment plans include a goal to promote self-control,
and educate patients on the prevention and management of behavioral
emergencies. Facility staff should provide patient debriefings
following all seclusion and restraint episodes.
In addition, Magellan encourages facilities to review and consider utilizing the joint document prepared by the American Psychiatric Association, the American Psychiatric Nurses Association and the National Association of Psychiatric Health Systems with support of the American Hospital Association Section for Psychiatric and Substance Abuse Services, entitled Learning from Each Other: Success Stories and Ideas for Reducing Restraint/Seclusion in Behavioral Health.
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