Current through Register Vol. 51, No. 19, September 20, 2024
A. Staff may not initiate "standing" or "as
needed" orders for restraint.
B. A
physician may write an order for restraint for a period of up to, but not more
than, 24 hours.
C. If a patient in
restraint requires continuous restraint for over a 24-hour period, a physician
shall:
(1) Conduct a face-to-face evaluation
of the patient to determine whether continuous restraint is
appropriate;
(2) Document the
evaluation in the patient's medical record; and
(3) If the patient is restrained under the
provisions of §§D and E of this regulation, carry out the
requirements of §C(1) and (2) of this regulation every 24 hours throughout
the period that the patient continues in restraint.
D. If restraint is required for a period
greater than a continuous 48 hours, the physician may continue restraint only:
(1) In conjunction with the requirements
outlined in this chapter;
(2) If
the treating physician's documented clinical opinion is that the patient, if
released from restraint, would continue to present a danger to self or others
or would present a serious disruption to the therapeutic environment;
and
(3) With the authorization of
the clinical director or the clinical director's physician designee, neither of
whom may be the treating physician.
E. Upon a request from a patient's treating
physician, the clinical director or the clinical director's designee identified
in §D(3) of this regulation, following a face-to-face evaluation of the
patient who is restrained, may authorize continued restraint:
(1) For category I restraints, for additional
periods of not more than 48 hours each over the initial 48-hour period that a
patient is restrained under the provisions of §C of this regulation;
and
(2) For category II restraints:
(a) For an initial period of not more than 7
days over the initial 48-hour period that a patient is restrained under the
provisions of §C of this regulation; and
(b) For additional periods of not more than 7
days each over the 7-day period of restraint authorized under §E(2)(a) of
this regulation, if the patient's treatment team:
(i) Recommends continued restraint and
documents the recommendation in the patient's medical record; and
(ii) Incorporates into the treatment plan and
any subsequent revisions to the plan the proposed strategies to accomplish
discontinuance of the restraint.
F. Each time that restraint is authorized
under the provisions of §E of this regulation, the clinical director or
the clinical director's designee identified in §D(3) of this regulation
shall countersign the physician's order in the patient's medical record for
continued restraint.
G. Treatment
Team Involvement.
(1) Minimally, at regularly
scheduled meetings, the patient's treatment team shall examine the use of
restraint for that patient.
(2)
Within 7 working days from the initiation of continuous restraint, regardless
of whether the patient remains in restraint, the treatment team shall:
(a) When applicable, review the
appropriateness of the continued use of restraint;
(b) Establish and implement a plan calculated
to eliminate the need for further restraint; and
(c) Identify a team member who shall explain
to the patient the potential risks and benefits of continuous
restraint.
