The Joint Commission monitors quality measures for the Midwestern hospital in the current study was to decrease the amount of time a patient is in seclusion for behavioral reasons to ≤ 2 hours. There was a 50% success rate. Other indicators monitored include regulatory requirement from the Joint Commission and Centers for Medicare & Medicaid Service (CMS): (a) presence of order; (b) face to face for seclusion including psychological status; physical safety and comfort; circulation, hydration; nutrition; and elimination. Reasons cited justifying seclusion included withdrawing the patient from an over stimulating environment and preventing endangerment of self or others. Meehan, Bergen, and Fjeldsoe (2004)