Are Timeouts really Seclusion?!?!?

Karina212 · Dec 3, 2004

i am interested in the answer to this also. the facility i just started working for in child psyche uses the seclusion room for time-outs without an order almost all of the time. sometimes, the child's in there for just ten minutes other times an hour or so. this seems very illegal....it doesn't sit well with me! what do other facilities do? please reply!!

cms definition of seclusion: involuntarily confining a patient alone in a room or area where he/she is physically prevented from leaving.
according to a workshop i went to, unless a patient is in 100% agreement to taking a timeout, the use of a timeout is seclusion and should be documented as such. this included situations where the patient voices that they do not want to take a timeout and the staff tells them they have to, so they do because it is implied they have to stay in their room or else...
just wondering how other facilities are working within this standard?!?!
setting is acute in-patient child and adult psych
thanks!!! tracy

windynights · Dec 7, 2004

Our facility uses Voluntary time outs, and does not consider them to be seclusions. We view them as a way to avoid having to seclude patients. We explain to the patients that we are trying to help them to avoid seclusion, and want them to voluntarily remain in their room to help them gain control of their behaviors. If they do not agree, or are unable to follow direction...and their behaviors are such that they might hurt themselves or others, then they are secluded. Time outs, and 1:1 staffing, and short-hall restrictions (where the patient can not go outside certain areas), are viewed as attempts by staff to avoid seclusion. We chart to the time outs as being voluntary...and maintain good communication with the patients, to insure they feel they are involved in the decision to time out in their rooms. We view it as a way to educate the patients, as to how they can maintain good behavioral control

Hukilau · Dec 8, 2004

It can be tricky. Many places I have worked use the same room for time out and seclusion. If the door is unlocked, it is called "time out." If the patient comes out without permission, the door is locked and the status changes to "seclusion." :uhoh3:

Actually, there is some logic to this. If a patient is displaying unacceptable/dangerous behavior, the first step is to see if they can gain control on their own, and if they can't then more severe measures might be called for. There have been times when patients may not have known that the door was unlocked. Clearly that would not be legal.

I have been a strong patient advocate for more than 20 years, but sometimes laws don't match needs. I always try to start with the least restrictive measures, but sometimes there are subtle nuances between stages of "force" that can't be written into a procedure.

Meraki · Dec 9, 2004

I work on a crisis child/adol psych unit. We have a time out/seclusion room (same room...voluntary / unlocked door = timeout, involuntary / locked door = seclusion) we use it only as a last resort. recently our management just decided that in order to seclude a patient they would have to certified, as they should have the choice of discharge over seclusion if they are a voluntary and competent patient...i have no clue how they plan to put this into practice???

we may set a firm limit that the expectation is that they stay in their room and the consequences of not doing so are a and b but if they attempted to leave they would not be physically stopped unless they were and immediate threat to themselves or others.

we also use team work alot. ie one staff would be dealing with the patient and another 3-5 staff members would stand around the doorway to deter the patient from choosing the option of leaving their room..."a show of force" again unless they were in the act of being violent we would not physically stop them if they chose to leave.

We also have the ability to lock doors to break our unit into 3 areas which limits someone's movements without completly confining them to one room, but also allows you to seperate them from the other kids.

Bjo · Dec 9, 2004

:nono: Where I work now and previously, anytime a patient is prevented from leaving the room, it is seclusion. It was practiced exactly as the standards indicate.

However, I know that there are ways around some of it too. Just be careful. What we think is therapeutic, surveyors think to be demeaning and punitive.

I think it's easier for an experienced person to understand the in's and out's of the whole seclusion/restraint issue.

Being on "the other side", so to speak, makes it difficult to see how dangerous it can be to not control a lot of situations we find ourselves in.

windynights · Dec 11, 2004

Our patients take their voluntary time outs in their own rooms, which are not seclusion rooms and have no locks on the doors.

They're either secluded or they're not. We have no involuntary time-outs. Didn't mean to imply that in my earlier message. We offer patients voluntary time-outs...and progress to seclusion if they are uncooperative and a risk for hurting themselves and/or others.

Bjo · Dec 11, 2004

Our patients take their voluntary time outs in their own rooms, which are not seclusion rooms and have no locks on the doors.
They're either secluded or they're not. We have no involuntary time-outs. Didn't mean to imply that in my earlier message. We offer patients voluntary time-outs...and progress to seclusion if they are uncooperative and a risk for hurting themselves and/or others.

I understood what you meant.:wink2: It is really a touchy subject. We do the voluntary timeouts, also. It isn't actually seclusion, but they are away from the stimulation of the milieu. Sometimes it works and sometimes it doesn't. If we have to seclude or restrain them, it is because we have tried everything else to control the situation. I know that years ago, we used to seclude and restrain more freely and it was a hard transition to limit that intervention.

jaycrue · Dec 11, 2004

Our facility calls voluntary isolation either in a clients bedroom or unlocked seclusion "theraputic quiet" should the client decide to come out he/she should be able to contract safety and behavioural issues. If these are not met seclusion is used and a psychiatrist needs to client within the hour.

Bjo · Dec 11, 2004

Our facility calls voluntary isolation either in a clients bedroom or unlocked seclusion "theraputic quiet" should the client decide to come out he/she should be able to contract safety and behavioural issues. If these are not met seclusion is used and a psychiatrist needs to client within the hour.

That sounds like basically what everyone is doing. At our facility, the doctors are getting really controlling. We can't be sure they will sign an order for the seclusion unless we call them and explain everything we have done and that we don't have any other option. It makes it a dangerous situation sometimes but that's what we have to follow or risk not having the order signed by the doctor.

jaycrue · Dec 11, 2004

That sounds like basically what everyone is doing. At our facility, the doctors are getting really controlling. We can't be sure they will sign an order for the seclusion unless we call them and explain everything we have done and that we don't have any other option. It makes it a dangerous situation sometimes but that's what we have to follow or risk not having the order signed by the doctor.

We are lucky in that sense, our Doctors seem to trust the nurses judgement, we usually give a verbal report over the phone and they give us a verbal order for seclusion and they sign it within 24 hrs.We also frequently recieve verbal orders for chemical restraints.

Bjo · Dec 11, 2004

We are lucky in that sense, our Doctors seem to trust the nurses judgement, we usually give a verbal report over the phone and they give us a verbal order for seclusion and they sign it within 24 hrs.We also frequently recieve verbal orders for chemical restraints.

We don't get orders for 'chemical restraints'. Something about the JCAHO standards or Medicaid or something. We give emergency medications, which is really the same thing of a different name.

So do you seclude first and then call the doctor? Or do you get the order first, before putting them in seclusion?