Hospital Conditions of Participation: Patient Rights
On July 2, 1999 the Health Care Financing Administration (HCFA) promulgated an interim final rule designed to strengthen existing patient protections in all hospitals participating in the Medicare and Medicaid programs. Six basic patient rights were specified in the regulation including the right to confidentiality of patient records and communications, and freedom from the inappropriate use of restraints and seclusion. HCFA has carved out the patient rights provisions from the larger proposed revision of the hospital Condition of Participation (COP) regulation, which was published as a Notice of Proposed Rule Making on December 17, 1997, in order to implement the expanded patient protections as soon as possible. During the public comment period on the interim final rule, ANA submitted comments to HCFA addressing specifically the restraint and seclusion sections of the rule, which contained a number of provisions that raised concerns about the impact of the rule on the quality of care and nursing practice.
In releasing these standards, HCFA noted its intent to ensure patient "freedom from the inappropriate use of restraints and seclusion" and to make its standards consistent with those of the Joint Commission of Accreditation of Health Care Organizations (JCAHO). ANA's major concerns are related to defining which health care providers are allowed to order the use of restraint and seclusion; the monitoring requirements of restraint and seclusion; and the agency's inappropriate lack of recognition of nursing practice and clinical judgement. The interim final rule requires a physician or other independent licensed practitioner face-to-face monitoring of restraint and/or restraint that was not part of the original proposed rule. ANA's comments addressed those concerns and offered alternative recommendations. The interim final rule went into effect on August 2, 1999. HCFA is currently reviewing all comments received during the public comment period in preparation for possible revisions to the final rule.