1. Patients Rights Condition of Participation Expected since 1999 (4,000 comments received) Effective January 8, 2007 Substantially revised the standards pertaining to restraint and seclusion. Standards apply to all Medicare and Medicaid participating hospitals, including psychiatric hospitals (except CAHs unless have DPUs) The definition of restraint was altered to adopt the definition contained in the Childrens Health Act of 2000 (Pub. L. 106- 310). The revised definition carves out an exception for certain devices, like orthopedically prescribed devices, surgical dressings or bandages, and protective helmets;

2. Patients Rights Condition of Participation The requirements relating to orders by a physician or licensed independent practitioner (LIP) were clarified to, among other things, require the attending physician to be promptly consulted if he or she is not the authorized individual (i.e., non-attending physician or LIP) who ordered the restraint or seclusion. The rule precludes the use of standing orders or on an as needed basis (PRN). The final rule retained the requirement that the orderwhich may endure for a maximum of 24 hoursmust be renewed every 4 hours for adults, 2 hours for children ages 9-17, and 1 hour for children under the age of 9

3. Patients Rights Condition of Participation Requires hospitals to provide patients or their family members with a formal notice of their rights on admission Clarifies that simultaneous use of restraint and seclusion is not permitted, unless the patient is continually monitored face-to-face by an assigned, trained staff member, or continually monitored by trained staff using both video and audio equipment. Imposes stricter standards for when a facility must report a death associated with the use of restraints or seclusion.

4. Patients Rights Condition of Participation Health care workers who employ physical restraints and seclusion when treating patients must undergo new, more rigorous training Broadens the class of practitioners allowed to perform the one hour face-to-face evaluation to include: –a physician or other LIP –a properly trained registered nurse –physicians assistant If the one hour evaluation is performed by an RN or PA, the attending physician or LIP who is responsible for the care must be consulted as soon as possible