Market Education

Automation of Special Treatment Procedures in TIER

CMS (formerly HCFA) and accreditation organizations such as JCAHO, COA, and CARF have implemented significant revisions in their standards related to use of special treatment procedures especially those that involve use of restraints or seclusion. The revisions were precipitated by several sentinel events in health care and behavioral health care organizations during the past few years. National advocacy groups have also exhibited a growing concern over need for such procedures as well as safe and human implementation and careful monitoring of their use. A number of new requirements have been incorporated into the revised standards.

The new standards require that organization leadership communicate its philosophy on the use of restraint and seclusion to all staff that have responsibilities for implementing these procedures. A major focus of the organization’s philosophy is to prevent, reduce, and try to eliminate use of restraint and seclusion. To underscore the emphasis on prevention, the new standards require that alternative interventions be explored with the patient at time of admission that can be used to prevent restraint or seclusion. In addition, the patient’s trauma history including sexual or physical abuse should be assessed.

The following is a copy of the special procedures order form from TIER^®:

The TIER^® Workflow System is a powerful resource to clinicians and clinical leadership because its Service Delivery Module provides a complete management system for use of restraint and seclusion. The system provides a process of data collection throughout the service continuum that captures key data at the appropriate time. This feature of the TIER^® system yields aggregate reports that provide information that is helpful as well as mandatory for compliance. The following information describes key requirements of the new standards along with an explanation as to how TIER^® addresses implementation of the standards.

TIER’s Service Delivery Module includes a “Behavioral Advance Directive” and a “Trauma Screening” to facilitate documentation of these requirements. The advance directive is used to describe alternative interventions that are agreed upon with the patient at the time of admission. Subsequently, if a procedure is required, the advance directive is automatically initialized into the order for the procedure as a way for staff to be sure that the advance directive was implemented and that nonphysical interventions were utilized.