AFFILIATE ORIENTATION MANUAL This policy designates the criteria used to determine if restraint and/or seclusion use is warranted to ensure a safe and therapeutic environment for all patients. The policy provides guidelines for assessment, use, management and monitoring of restraint and seclusion, limiting the use of restraint and seclusion and preserving the individual’s safety and dignity. Philosophy Cone Health leadership recognizes that all patients have the right to respectful care and consideration of their rights, dignity and safety. Restraints and seclusion are only utilized when less restrictive interventions have been determined ineffective to protect the patient, staff members and others from harm. Policy Restraint or seclusion will be used only when adequate and appropriate clinical justification exists. Restraint, seclusion or isolation time-out may be necessary to ensure patient safety during hospitalization. Seclusion is only to be used at the Behavioral Health campus and the Wesley Long secured area for psychiatric patients. Preventive strategies and/or use of less restrictive alternatives must be explored before implementation of restraint, seclusion or isolation time-out. Use of restraint, seclusion, or isolation time-out: • Will be based on the assessed needs of the patient. • Will never be used as a convenience for staff or as punishment, coercion or retaliation by staff. In addition, the use of restraint or seclusion will never be based on: • A patient’s restraint or seclusion history. • Solely on a history of dangerous behavior. Restraint for a violent or self-destructive reason is used only as an emergency measure and is reserved for those occasions when severely aggressive or destructive behavior places the patient or others in imminent danger. Restraint is used only after alternative measures have been exhausted or are not viable. The attempt to use alternative measures must be documented in the medical record. The specific device used to restrain a patient does not in itself determine whether these standards apply. Rather it is the device’s intended use, its involuntary application, and/or the identified patient need that determines whether use of the device triggers the application of this policy. Therefore, this policy does not apply for standard practices that include limitation of mobility or temporary immobilization related to medical, dental, diagnostic, or surgical procedures and the related post-procedure care processes. For more information, contact departmental leadership. RESTRAINT and SECLUSION POLICY Cone Health has policies and guidelines for withholding or discontinuing treatment and are intended to provide a method by which patients and/ or their representatives may exercise these rights and to provide guidance and legal protection to physicians and hospital personnel. Policy Each patient shall receive all necessary and appropriate treatment unless and until the physician issues an order to withhold or discontinue treatment. Care and service will be provided to dying patients in the most sensitive and humane manner prudent under the circumstances. When consistent with this policy, it is ethical to withhold or discontinue medical treatment, including artificial nutrition and hydration. The health care team is responsible for providing the supportive therapy and care necessary to maintain patient dignity and quality of life. For more information, contact departmental leadership. RIGHT to NATURAL DEATH POLICY 29