Are Timeouts really Seclusion?!?!?

jaycrue · Dec 11, 2004

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?

we seclude first then call the Dr.

Got a question: A client came in with a crack pipe and some I assume crack and cocaine (small bag) client was disorriented. what do you do with the drugs?

I left work before they decided on what to do?

Bjo · Dec 11, 2004

we seclude first then call the Dr.
Got a question: A client came in with a crack pipe and some I assume crack and cocaine (small bag) client was disorriented. what do you do with the drugs?
I left work before they decided on what to do?

We have police officers on campus, so we would write out the incident report and then make all the necessary notifications, and turn it over to the police officers.

jaycrue · Dec 11, 2004

We have police officers on campus, so we would write out the incident report and then make all the necessary notifications, and turn it over to the police officers.

this situation seems to be a first for us, clients seem to use up the drugs before coming to crisis, Police officers on campus ha! I wish. Incident report was filled out though, I just hope the client was made aware that the drugs were disposed off or hopefully done in front of him! he might think we took it :rotfl:

chad75 · Dec 18, 2004

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???

Well, you probably shouldn't be putting a patient in seclusion if they aren't a danger to themselves or others, so that issue pretty much solves its self. If they are a danger to themselves or others and on voluntary status you couldn't let them go either. Call the doc and get an order for a 72 hour hold .

The whole thing is pretty subjective, having worked places like state mental health institutions which occasionally end up keeping patients a very long time (>1 year on an "acute" unit) you have to wonder if just the fact of asking an instutionalized patient if he would please take a time out is not in and of it self seclusion since he/she knows if they refuse 9 out of 10 times they will end up in seclusion.

Same thing with the unlocked door quiet room, come out and we lock it...isn't that truely seclusion? Yeah Its semantics, and we all have played that game, even JCHO, with the no chemical restraints issue...umm okay no chemical restraints, we just have an order for 10 and 2 q1 hour until "no longer emergent" ROFLMAO...

Bjo · Dec 19, 2004

Well, you probably shouldn't be putting a patient in seclusion if they aren't a danger to themselves or others, so that issue pretty much solves its self. If they are a danger to themselves or others and on voluntary status you couldn't let them go either. Call the doc and get an order for a 72 hour hold .
The whole thing is pretty subjective, having worked places like state mental health institutions which occasionally end up keeping patients a very long time (>1 year on an "acute" unit) you have to wonder if just the fact of asking an instutionalized patient if he would please take a time out is not in and of it self seclusion since he/she knows if they refuse 9 out of 10 times they will end up in seclusion.
Same thing with the unlocked door quiet room, come out and we lock it...isn't that truely seclusion? Yeah Its semantics, and we all have played that game, even JCHO, with the no chemical restraints issue...umm okay no chemical
restraints, we just have an order for 10 and 2 q1 hour until "no longer emergent" ROFLMAO...

I work in a state hospital and you are absolutely right!

We have never had the 10 & 2 order q1 hour, though. But you are right. It is a game that we have all played, and learned to play well. Our skill can be attributed to JCAHO because of the limits they have put on us and our ability to keep the place safe for everyone. :eek:

elkpark · Jan 2, 2005

I am a psych CS with many years of experience who has also worked as a state and Federal surveyor/regulator, and I am alarmed at all the comments on this thread about locking the door if people come out, etc. The federal standards (CMS, who are the ones you really need to worry about, and JCAHO, who are mostly just for show) are very clear -- seclusion is when you isolate clients from their peers and physically prevent them from leaving a space, and the only justification for secluding someone is that s/he is acutely dangerous to her/himself or others. Timeouts are voluntary (using the seclusion room with the door unlocked is fine and often v. therapeutic in the sense of reducing stimulation). "Involuntary timeouts" (??) are probably seclusion, regardless of what they get called -- whether you lock a door or have staff standing around an open door, if the person is prevented from walking out into the hall if they choose to, THAT IS SECLUSION, and requires a physician's order, face-to-face evaluation within one hour, and the whole nine yards (and, in that case, you might as well go ahead and lock the door and let the staff get back to what they were doing ... :) ) If someone is in "time out" and walks out of the room, unless that person is acutely dangerous to her/himself or others at the time, you cannot legally lock them in.

I realize there are lots of ways to finesse the rules and just plain "cheat," but you would be surprised at how often my team has figured out in investigations what really happened, and cited the hospital anyway, even though the staff thought they were being v. clever about using the right language to protect themselves. We have also cited for using chemical restraint without following all the requirements (same as restraint/seclusion -- face-to-face eval within 1 hour, required documentation, etc.) when the situation met the CMS definition of chemical restraint, regardless of what the hospital called it.

Nobody is saying you can't restrain or seclude or medicate people who need it to be kept safe -- just that you have to follow the required procedures when it's justified, and you can't abuse people by using restrictive techniques if they're not justified.

How hard is it to do things right, and treat people the way you would want to be treated if it were you? Remember, all the current picky little rules that seem so onerous now were developed in response to abuses of patients committed by the psych community in the past. Believe me, nobody in the state or federal governments cares enough about psych patients to just sit around and think up ways to improve their lot -- all the rules were written reactively, in response to bad situations and practices ...

Sorry for the long rant :) -- hang in there!

Bjo · Jan 3, 2005

If the person is making verbal threats, hitting the walls, throwing chairs and tables, and making the whole place a volitile situation, then they need to be secluded. If they are secluded and they start to bang their heads, or tie their clothes around their necks, they need restrained. If they can't calm down, then don't you think it would be sensible to give them "something" to help them calm down instead of renewing the restraint over and over. I agree that the people need to be protected, but I also think there are some who don't respond to anything you do.