Restraint Death Reporting

CMS published QSO-20-04 on December 2nd covering restraint death reporting. It details a new electronic death reporting form #10455 that they want you to start using as of December 2. CMS will continue to accept paper forms but only until December 31. The death reporting requirements remains the same. The reporting process is the only thing that CMS is changing.

Restraint Death Reporting

The reporting must include deaths related to the following:

• While in restraint, seclusion or both. The one exception is those in which only 2-point soft wrist restraints were in use and the patient was not in seclusion at the time of death
• Within 24 hours of the removal of restraint, seclusion or both. This also excludes those in which only 2-point soft wrist restraints were in use and the patient was not in seclusion within 24 hours of their death
• Within 7 days where the use of restraint, seclusion or both is reasonable to assume contributed to the patient’s death.

Attached to the QSO memo is a slide show describing how to access and use the new electronic form. CMS created an instructional video on how to complete the form. You can access this information on their surveyor training website.

The QSO memo also details the specific fields of information you must submit. But, because you are filling in the blanks on the form, this is simple.