Current through Register Vol. 50, No. 9, September 20, 2024
A. Safety and Supervision. Interventions to
manage inappropriate client behavior must be used within sufficient safeguards
and supervision to insure that the safety, welfare, and civil and human rights
of clients are adequately protected. These interventions must:
1. never be used:
a. for disciplinary purposes;
b. for the convenience of staff; or
c. as a substitute for an active treatment
program;
2. never
include corporal punishment;
3.
never include discipline of one client by another except as part of an
organized system of self government as set forth in facility policy.
B. Individual Plans and Approval.
Individual programs to manage inappropriate client behavior must be
incorporated into the client's individual program plan and must be reviewed,
approved, and monitored by the Specially Constituted Committee. Written
informed consent by the client or legal representative is required prior to
implementation of a behavior management plan involving any risks to client's
rights. (See Chapter 315, Client Rights, which addresses informed
consent.)
C. Standing Programs.
Standing or as needed programs to control inappropriate behavior are not
permitted. To send a client to his room when his behavior becomes inappropriate
is not acceptable unless part of a systematic program of behavioral
interventions for the individual client.
D. Time-out Rooms
1. Use of time-out rooms is not permitted in
group or community homes.
2. In
institutional settings, it is permitted only when professional staff is on-site
and only under the following conditions:
a.
the placement in a time-out room is part of an approved systematic behavior
program as required in the individual program to manage inappropriate behavior
discussed under
§31303. A 1-3;
emergency placement is not allowed;
b. the client is under direct constant visual
supervision of designated staff;
c.
if the door to the room is closed, it must be held shut only by use of constant
physical pressure from a staff member;
d. placement in time-out room does not exceed
one hour;
e. clients are protected
from hazardous conditions while in time-out rooms;
f. a record is kept of time-out
activities.
E. Physical Restraint. Physical
restraint is defined as any manual method or physical or mechanical
device that the individual cannot remove easily and which restricts free
movement.
1. Examples of manual methods
include:
a. therapeutic or basket holds;
and
b. prone or supine
containment.
2. Examples
of physical or mechanical devices include:
a.
barred enclosure which must be no more than 3 feet in height and must not have
tops;
b. chair with a lap tray used
to keep an ambulatory client seated;
c. wheelchair tied to prevent movement of a
wheelchair mobile client;
d. straps
used to prevent movement while client is in chair or bed.
3. Physical restraints can be used only:
a. when absolutely necessary to protect the
client from injuring himself or others in an emergency situation;
b. when part of an individual program plan
intended to lead to less restrictive means of managing the behavior the
restraints are being used to control;
c. as a health related protection prescribed
by a physician but only if absolutely necessary during a specific medical,
dental, or surgical procedure or while a medical condition exists;
d. when the following conditions are met:
i. orders for restraints are not obtained for
use on a standing or on an as needed basis;
ii. restraint authorizations are not in
effect longer than 12 consecutive hours and are obtained as soon as possible
after restraint has occurred in emergency situations;
iii. clients in restraints are checked at
least every 30 minutes and released as quickly as possible. Record of restraint
checks and usage is required;
iv.
restraints are designed and used so as not to cause physical injury and so as
to cause the least possible discomfort;
v. opportunities for motion and exercise are
provided for not less than 10 minutes during each two-hour period and a record
is kept; and
vi. restraints are
applied only by staff who have had training in the use of these
interventions.
F. Drugs. Drugs used for control of
inappropriate behavior may be used only under the following conditions:
1. drugs must be used only in doses that do
not interfere with the client's daily living activities;
2. drugs used for control of inappropriate
behavior must be approved by the interdisciplinary team, the client, legal
representative, and specially constituted committee. These drugs must be used
only as part of the client's individual program plan that is directed toward
eliminating the behavior the drugs are thought to control;
3. prior to the use of any program involving
a risk to client protection and rights, including the use of drugs to manage
inappropriate behavior, written informed consent must be obtained from:
a. client; or
b. family, legal representative, or advocate
if client is a minor or client is mentally unable to understand the intended
program or treatment;
4.
informed consent consists of permission given voluntarily on a time limited
basis not to exceed 365 days by the client or the legally appropriate party
after having been informed of the:
a.
specific issue treatment or procedure;
b. client's specific status with regard to
the issue;
c. attendant risks
regarding the issue;
d. acceptable
alternatives to the issue;
e. right
to refuse;
f. consequences of
refusal;
5. drugs must
not be used until it can be justified that the beneficial effects of the drug
on the client's behavior clearly outweighs the potentially harmful effects of
the drug;
6. drugs must be clearly
monitored in conjunction with the physician, the pharmacist, and facility
staff;
7. unless clinical evidence
justifies that this is contraindicated, drugs for control of inappropriate
behavior must be gradually reduced at least annually in a carefully monitored
program conducted in conjunction with the interdisciplinary team.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
36:254, R.S. 40.2009.2,
R.S.
40:2009.20, R.S. 403.2,
42 CFR
483.420,
483.440, and
483.450.
