Current through Register Vol. 46, No. 19, March 20, 2024
(1)
Use of a seclusion room. Pursuant to Iowa Code section
135G.3(2),
a seclusion room used by a subacute care facility must meet the conditions of
42
CFR §
483.364(b).
a. A subacute care facility utilizing a
seclusion room shall have written policies regarding its use. The policy shall:
(1) Specify the types of behavior that may
result in seclusion room placement.
(2) Delineate the licensed personnel who may
authorize use of the seclusion room.
(3) Require documentation of the time in the
seclusion room, the reasons for use of the seclusion room, and the reasons for
any extension of time beyond one hour. Under no circumstances shall the use of
the seclusion room exceed four hours.
(4) Require notice to residents of the types
of behavior that may result in seclusion room placement.
b. A staff member shall always be in hearing
distance of the seclusion room, and the resident shall be visually checked by
the staff at least every 15 minutes. Every check shall be documented in
writing.
c. A seclusion room shall
not be used for punishment, for the convenience of staff, or as a substitution
for supervision. A seclusion room shall only be used when a less restrictive
alternative has failed and:
(1) In an
emergency to prevent injury to the resident or to others; or
(2) For crisis intervention.
(2)
Use of
restraints. There shall be written policies that define the use of
restraint, designate the staff member who may authorize its use, and establish
a mechanism for monitoring and controlling its use.
a. Restraint shall not be used for
punishment, for the convenience of staff, or as a substitution for supervision.
Restraint shall only be used:
(1) In an
emergency to prevent injury to the resident or to others; or
(2) For crisis intervention.
b. Restraint must not result in
harm or injury to the resident and must be used only to ensure the safety of
the resident or others during an emergency situation until the emergency
situation has ceased, even if the restraint order has not expired.
c. The use of restraint should be selected
only when other less restrictive measures have been found to be ineffective to
protect the resident or others. The staff shall demonstrate effective treatment
approaches and alternatives to the use of restraint.
d. Under no circumstances shall a resident be
allowed to actively or passively assist in the restraint of another
resident.
e. Staff trained in the
use of emergency safety interventions must be physically present and
continually assessing and monitoring the well-being of the resident and the
safe use of restraint throughout the duration of the emergency
situation.
(3)
Orders for restraint or seclusion. An order for restraint or
seclusion shall not be written as a standing order or on an as-needed basis.
a. Each order for restraint or seclusion
shall include:
(1) The name of the ordering
physician, physician assistant or advanced registered nurse
practitioner.
(2) The date and time
the order is obtained.
(3) The
emergency safety intervention ordered, including the length of time for which
restraint or seclusion is authorized.
b. Orders for restraint or seclusion must be
by a physician, physician assistant or advanced registered nurse practitioner.
(1) Verbal orders must be received while the
emergency safety intervention is being initiated by staff or immediately after
the emergency safety situation ends and must be verified in writing in the
resident's record by the physician, physician assistant or advanced registered
nurse practitioner.
(2) Once the
one-time order for the specific resident in an emergency safety situation has
expired, it may not be renewed on a planned, anticipated, or as-needed
basis.
(4)
Simultaneous use prohibited. Restraint and seclusion shall not
be used simultaneously.
(5)
Documentation of use of restraint or seclusion. Staff must
document in the resident's record and in a centralized tracking system any use
of restraint or seclusion.
a. Documentation
must be completed by the end of the shift in which the intervention occurs or
during the shift in which it ends.
b. Documentation shall include:
(1) The order for restraint or
seclusion.
(2) The time the
emergency safety intervention began and ended.
(3) The emergency safety situation that
required restraint or seclusion.
(4) The name of staff involved in the
emergency safety intervention.
(5)
The interventions used and their outcomes.
(6) The signature of the physician, physician
assistant or advanced registered nurse practitioner.
(6)
Meeting to
process restraint or seclusion. As soon as reasonably possible after
the restraint or seclusion of a resident has terminated, staff must meet to
process the restraint or seclusion occurrence and document in writing the
meeting.
(7)
Multiple
occasions of restraint or seclusion. A resident who requires restraint
or seclusion on multiple occasions should be considered for a higher level of
care.
(8)
Staff
training. The facility shall provide to the staff training by
qualified professionals on physical restraint and seclusion theory and
techniques.
a. The facility shall keep a
record of the training, including attendance, for review by the
department.
b. Only staff who have
documented training in physical restraint and seclusion theory and techniques
shall be authorized to assist with the seclusion or physical restraint of a
resident.
