Louisiana Administrative Code
Title 48 - PUBLIC HEALTH-GENERAL
Part III - Mental Health Services
Chapter 3 - Client Services
Section III-311 - Restraint and Seclusion

1. Restraint or seclusion shall only be used when verbal intervention or less restrictive measures fail. Use of restraint or seclusion shall require documentation in the patient's record of the clinical justification for such use as well as the inadequacy of the less restrictive intervention techniques.

2. A written order from a physician is required for any use of restraint or seclusion.

3. In a non-emergency situation, the physician shall conduct a clinical assessment of the patient before writing the order for use of restraint or seclusion.

4. In an emergency, nursing personnel who have been trained in management of disturbed behavior may utilize restraint or seclusion. Nursing personnel shall then immediately notify the nursing supervisor who will observe and assess the patient. The nursing supervisor will then notify the physician and obtain an order. The physician will, as soon as possible, and, in no instance more than one hour after initiation, conduct a clinical assessment of the patient and give a written order.

5. Written orders for the use of restraint or seclusion shall be time limited and preferably not more than four hours in duration. In no instance shall it exceed 12 hours without a new order. If restraint or seclusion is utilized for longer than 24 hours, written approval of the head of the professional staff shall be required.

6. Staff who implement written orders for restraint or seclusion shall have documented training in the proper use of the procedure for which the order was written.

7. The registered nurse shall assign a responsible person for continuous monitoring and care of the patient. A patient in restraint or seclusion shall be evaluated every 15 minutes, especially in regard to regular meals, bathing, and use of the toilet, and appropriate documentation shall be entered in the patient's record. Blood pressure, pulse, and respiration shall be taken and recorded at least once per shift. If the responsible person is unable to obtain said vital signs, the reason(s) shall be documented.

8. Patients are to be taken out of restraint or seclusion as soon as it is determined that the reasons for this no longer exists, i.e., patient is in control and no longer dangerous to self or others or severely disruptive to the therapeutic environment.

9. PRN (as needed) orders shall not be used to authorize the use of restraint or seclusion. Locked door seclusion is not to be used with any Gary W. clients. All uses of restraint or seclusion (summarizing types used, duration, and reasons) shall be reported daily to the head of the professional staff who shall review and investigate any unusual or possibly unwarranted patterns of utilization. A copy of this report shall also be sent to the superintendent.