Archive for the ‘Department of Health Services’ Category

Maneuvers and Techniques Prohibited in Community Based Programs and Facilities

Thursday, February 9th, 2017

Wisconsin Prohibited Maneuvers and Techniques in Community Based Programs

Wisconsin Behavioral Health Managing Aggressive Behaviors

Wisconsin Behavioral Health Lawyer

The Wisconsin Department of Health Services (DHS) as released a memo that specifies maneuvers or techniques that may not be used at any time in community based programs and facilities. DHS deems the prohibited maneuvers or techniques to “present an inherently high risk of serious injury and even death.”  Providers are directed by DHS to immediately discontinue the use of any of the listed maneuvers.  Prohibited maneuvers, techniques, and procedures that may not be used under any circumstances include:

  • Any maneuver or technique that does not give adequate attention and care to protection
    of the head.
  • Any maneuver or technique that places pressure or weight on the chest, lungs, sternum,
    diaphragm, back, or abdomen.
  • Any maneuver or technique that places pressure, weight, or leverage on the neck or throat, on any artery, or on the back of the head or neck, or that otherwise obstructs or restricts the circulation of blood or obstructs an airway, such as straddling or sitting on the torso, or any type of choke hold.
  • Any maneuver or technique that involves pushing into a person’s mouth, nose, or eyes.
  • Any maneuver or technique that utilizes pain to obtain compliance or control, including punching, hitting, hyperextension of joints, or extended use of pressure points.
  • Any maneuver or technique that forcibly takes a person from a standing position to the floor or ground. This includes taking a person from a standing position to a horizontal (prone or supine) position or to a seated position on the floor.
  • Any maneuver or technique that creates a motion causing forcible impact on the person’s head or body, or forcibly pushes an individual against a hard surface.
  • The use of seclusion where the door to the room would remain locked without someone having to remain present to apply some type of constant pressure or control to the locking mechanism.

DHS explains in the memo that the ultimate goal is to replace such interventions with trauma-informed systems and settings, positive behavior supports, and non-coercive intervention strategies. DHS promotes recovery and healing that is consumer-driven, person-centered, trauma-informed, and recovery-based.

In addition to describing measures that are completely prohibited, DHS states that restrictive measures that are not prohibited may only be used in emergency situations in which there is an imminent risk of serious harm to self or others, or as part of an approved plan. Situations in which the person’s behavior was foreseeable based on his or her
history are not considered an emergency.   Even restrictive measures that are not directly prohibited must be avoided whenever possible and may only be used after all other feasible alternatives, including de-escalation techniques, have been exhausted. When necessary, restrictive measures may only be used with the minimum amount of force needed, and for the shortest duration possible, to restore safety.

Facilities should review their policies and practices to assure compliance with the guidelines set forth in the memo. Additional staff training should be conducted to assure compliance with these standards.   Additionally, providers should become familiar with the changing standards of care and best practices focused on building skills and techniques to de-escalate and redirect behaviors that present safety concerns, and work earnestly to promote a trauma-informed culture of care.

New Physician Assistant Supervision Requirements Effective March 1

Tuesday, March 11th, 2014

Wisconsin MEB Changes PA Supervision Requirements

The Wisconsin Medical Examining Board (MEB) recently approved several changes impacting physician supervision of physician assistants (PAs) in Wisconsin. These revisions are reflected in the Wisconsin Administrative Code Med 8 (Med 8) and became effective March 1, 2014. It is important that physicians be aware of the changes and the impact the revisions may have on their practice.

Here’s an overview of the key changes:

Supervising Physician to Ratio
A supervising physician may now simultaneously supervise four, rather than two, on-duty PAs. There is no limit to the number of PAs that a physician can supervise over time, and a PA may be supervised by more than one physician while on duty. A physician may still request authorization from the MEB to supervise additional PAs.

PA Prescribing
PA prescribing is simplified under Med 8. A PA may prescribe orders for drugs provided the PA’s prescriptive practices are initially reviewed, and at least annually reviewed after the initial review, by a supervising physician. Reviews must be documented and signed by the supervising physician, and the PA must be available to the MEB upon request.

Identifying the Supervising Physicians
Med 8 adds the requirement that the supervising physician must be readily identifiable by the PA. The rule does not require a specific manner of documentation—just that it is being documented.

Substitute Supervising Physicians
Substitute supervising physicians no longer need to be reported to the MEB.

On-Site Visit and Review of PA Practice Locations
A supervising physician is no longer required to make a monthly visit and on-site review of each facility where the PA practices.

The full text of Med 8 is available online. Physicians who supervise PAs should be conscious of the new requirements and adjust their practices accordingly to ensure compliance.

MSA Metropolitan Statistical Areas Wisconsin

Thursday, April 11th, 2013

Metropolitan Statistical Areas in the State of Wisconsin

Wisconsin contains 11 Metropolitan statistical areas that are totally within the state and an additional four MSAs that overlap state borders.  The Wisconsin MSAs include the following areas:

1.         Appleton (Outagamie and Calumet)

2.         Eau Claire (Eau Claire and Chippewa)

3.         Fond du Lac (Fond du Lac(

4.         Green Bay (Brown, Oconoto and Kewaunee)

5.         Janesville (Rock)

6.         Madison (Dane, Columbia and Iowa)

7.         Milwaukee-Waukesha-West Allis (Milwaukee, Waukesha, Ozaukee and Washington)

8.         Oshkosh-Neenah (Winnebago)

9.         Racine (Racine)

10.       Sheboygan (Sheboygan)

11.       Wausau (Marathon)

The four cross-border MSAs applicable to the State of Wisconsin include:

1.         La Crosse (La Crosse/WI plus Houston/MN

2.         Minneapolis-St. Paul-Bloomington (Anoka, Carver, Chicago, Dakota, Hennepin, Isanti, Ramsey, Scott, Sherburne, Washington and Wright/MN plus Pierce and St. Croix, Wisconsin)

3.         Duluth (Carlton and St. Louis/MN plus Douglas, WI

4.         Chicago-Naperville-Joliet (Cook, Dekalb, DuPage, Grundy, Kane, Kendall, Lake, McHenig and Will/IL plus Jasper, Lake, Newton and Porter/IN plus Kenosha, WI

Wisconsin Department of Health Services – QuickLinks

Thursday, July 30th, 2009

Wisconsin Department of Health Services Resource Links

Wisconsin Department of Health ServicesWisconsin DHS Main Page

Certification, Licensing and Permitting

DHS Division of Long Term Care

DHS Office of Inspector General

DHS Division of Quality Assurance

 DHS Office of Legal Counsel

 Division of Quality Assurance ListServ

 DQA Facility Register

 DQA Provider Training