Current through Register Vol. 49, No. 13, September 23, 2024
Subpart
1.
Certification required.
A license holder who wishes to use a restrictive procedure
with a resident must meet the requirements of this part to be certified to use
restrictive procedures with a resident.
Subp. 2.
Restrictive procedures plan
required.
The license holder must have a restrictive procedures plan
for residents that is approved by the commissioner of human services or
corrections, and the plan must provide at least the following:
A. the plan must list the restrictive
procedures and describe the physical holding techniques which will be used by
the program;
B. how the license
holder will monitor and control the emergency use of restrictive
procedures;
C. a description of the
training that staff who use restrictive procedures must have prior to staff
implementing the emergency use of restrictive procedures, which includes at
least the following:
(1) the needs and
behaviors of residents;
(2)
relationship building;
(3)
alternatives to restrictive procedures;
(4) de-escalation methods;
(5) avoiding power struggles;
(6) documentation standards for the use of
restrictive procedures;
(7) how to
obtain emergency medical assistance;
(8) time limits for restrictive
procedures;
(9) obtaining approval
for use of restrictive procedures;
(10) requirement for updated training at
least every other year; and
(11)
the proper use of the restrictive techniques approved for the
facility;
D. the license
holder must prepare a written review of the use of restrictive procedures in
the facility at least annually; and
E. the license holder must ensure that the
resident receives treatment for any injury caused by the use of a restrictive
procedure.
Subp. 3.
Department of Human Services licensed facilities.
License holders who are licensed by the Department of Human
Services and certified by the Department of Human Services to provide
residential treatment for children with a severe emotional disturbance and
children in need of shelter care may seek certification to use one or more of
the following restrictive procedures:
A. physical escort;
B. physical holding;
C. seclusion; and
D. the limited use of mechanical restraint
only for transporting a resident.
Subp. 4.
Department of Corrections
licensed facilities.
License holders who are licensed by the Department of
Corrections may seek certification to use one or more of the following
restrictive procedures:
A. physical
escort;
B. physical
holding;
C. seclusion;
D. mechanical restraints; and
E. disciplinary room time. Disciplinary room
time may be secure or nonsecure. Disciplinary room time may be used as a
consequence for resident behavior as permitted in the facility's restrictive
procedures plan. If disciplinary room time is used at the facility, the
facility restrictive procedures plan must:
(1)
provide for a system of due process for residents who violate facility
rules;
(2) contain a written set of
facility rules of conduct which includes a description of the consequences or
penalties for infractions of facility rules; and
(3) require that the written facility rules
must be given to each resident and explained and made available to each
resident at the time of admission. The facility rules must be explained to a
resident in a language that the resident understands.
Subp. 5.
Physical escort
requirements.
The physical escort of a resident is intended to be a
behavior management technique that is minimally intrusive to the resident. It
is to be used to control a resident who is being guided to a place where the
resident will be safe and to help de-escalate interactions between the resident
and others. A license holder who uses physical escort with a resident must meet
the following requirements:
A. staff
must be trained according to subpart
2, item C;
B. staff must document the use of physical
escort and note the technique used, the time of day, and the name of the staff
person and resident involved; and
C. the use of physical escort must be
consistent with the resident's case plan or treatment plan.
Subp. 6.
Use of physical
holding or seclusion.
Physical holding and seclusion are behavior management
techniques which are used in emergency situations as a response to imminent
danger to the resident or others and when less restrictive interventions are
determined to be ineffective. The emergency use of physical holding or
seclusion must meet the conditions of items A to M:
A. an immediate intervention is necessary to
protect the resident or others from physical harm;
B. the physical holding or seclusion used is
the least intrusive intervention that will effectively react to the
emergency;
C. the use of physical
holding or seclusion must end when the threat of harm ends;
D. the resident must be constantly and
directly observed by staff during the use of physical holding or
seclusion;
E. the use of physical
holding or seclusion must be used under the supervision of a mental health
professional or the facility's program director;
F. physical holding and seclusion may be used
only as permitted in the resident's treatment plan;
G. staff must contact the mental health
professional or facility's program director to inform the program director
about the use of physical holding or seclusion and to ask for permission to use
physical holding or seclusion as soon as it may safely be done, but no later
than 30 minutes after initiating the use of physical holding or
seclusion;
H. before staff uses
physical holding or seclusion with a resident, staff must complete the training
required in subpart
2 regarding the use of
physical holding and seclusion at the facility;
I. when the need for the use of physical
holding or seclusion ends, the resident must be assessed to determine if the
resident can safely be returned to the ongoing activities at the
facility;
J. staff must treat the
resident respectfully throughout the procedure;
K. the staff person who implemented the
emergency use of physical holding or seclusion must document its use
immediately after the incident concludes. The documentation must include at
least the following information:
(1) a
detailed description of the incident which led to the emergency use of physical
holding or seclusion;
(2) an
explanation of why the procedure chosen needed to be used to prevent or stop an
immediate threat to the physical safety of the resident or others;
(3) why less restrictive measures failed or
were found to be inappropriate;
(4)
the time the physical hold or seclusion began and the time the resident was
released;
(5) in at least 15-minute
intervals during the use of physical holding or seclusion, documentation of the
resident's behavioral change and change in physical status that resulted from
the use of the procedure; and
(6)
the names of all persons involved in the use of the procedure and the names of
all witnesses to the use of the procedure;
L. the room used for seclusion must be well
lighted, well ventilated, clean, have an observation window which allows staff
to directly monitor a resident in seclusion, fixtures that are tamperproof,
with electrical switches located immediately outside the door, and doors that
open out and are unlocked or are locked with keyless locks that have immediate
release mechanisms; and
M. objects
that may be used by a resident to injure the resident's self or others must be
removed from the resident and the seclusion room before the resident is placed
in seclusion.
Subp. 7.
Use of mechanical restraints.
Mechanical restraints are a behavior management device which
may be used only when transporting a resident or in an emergency as a response
to imminent danger to a resident or others and when less restrictive
interventions are determined to be ineffective. A facility that uses mechanical
restraints must include mechanical restraints in its restrictive procedures
plan. The emergency use of mechanical restraints must meet the conditions of
items A to J:
A. an immediate
intervention is necessary to protect the resident or others from physical
harm;
B. the mechanical restraint
used is the least intrusive intervention that will effectively react to the
emergency;
C. the use of mechanical
restraint must end when the threat of harm ends;
D. the resident must be constantly and
directly observed by staff during the use of mechanical restraint;
E. the use of mechanical restraint must be
supervised by the program director or the program director's
designee;
F. mechanical restraint
may be used only as permitted in the resident's treatment plan;
G. as soon as it may safely be done, but no
later than 60 minutes after initiating the use of a mechanical restraint, staff
must contact the facility's program director or the program director's designee
to inform the program director about the use of a mechanical restraint and to
ask for permission to use the mechanical restraint;
H. before staff uses a mechanical restraint
with a resident, staff must complete training in the use of the types of
mechanical restraints used at the facility;
I. when the need for the use of mechanical
restraint ends, the resident must be assessed to determine if the resident can
safely be returned to the ongoing activities at the facility; and
J. the staff person who used mechanical
restraint must document its use immediately after the incident concludes. The
documentation must include at least the following information:
(1) a detailed description of the incident or
situation which led to the use of the mechanical restraint;
(2) an explanation of why the mechanical
restraint chosen was needed to prevent an immediate threat to the physical
safety of the resident or others;
(3) why less restrictive measures failed or
were found to be inappropriate;
(4)
the time when the use of mechanical restraint began and the time when the
resident was released from the mechanical restraint;
(5) in at least 15-minute intervals during
the use of mechanical restraints, documentation of the observed behavior change
and physical status of the resident that resulted from the use of mechanical
restraint; and
(6) the names of all
the persons involved in the use of mechanical restraint and the names of all
witnesses to the use of mechanical restraint.
Subp. 8.
Disciplinary room time
use.
Disciplinary room time must be used only for major violations
and be used according to the facility's restrictive procedures plan. In
addition to the restrictive procedures plan requirements in subpart
2, the license holder who
uses disciplinary room time must meet the following requirements:
A. the license holder must give the resident
written notice of an alleged violation of a facility rule;
B. the license holder must tell the resident
that the resident has a right to be heard by an impartial person regarding the
alleged violation of facility rules; and
C. the license holder must tell the resident
that the resident has the right to appeal the determination made by the
impartial person in item B internally to a higher authority at the
facility.
Subp. 9.
Training for staff using physical holding or seclusion.
In addition to the training in subpart
2, item C, staff who use
physical holding or seclusion must have the following training before using
physical holding or seclusion with a resident:
A. documentation standards for physical
holding and seclusion;
B.
thresholds for employing physical holding or seclusion;
C. the physiological and psychological impact
of physical holding and seclusion;
D. how to monitor and respond to the
resident's physical signs of distress;
E. symptoms and interventions for positional
asphyxia; and
F. time limits and
procedures for obtaining approval of the use of physical holding and seclusion.
Training must be updated at least once every two
years.
Subp. 10.
Administrative review.
The license holder must complete an administrative review of
the use of a restrictive procedure within three working days after the use of
the restrictive procedure. The administrative review must be conducted by
someone other than the person who decided to impose the restrictive procedure,
or that person's immediate supervisor. The resident or the resident's
representative must have an opportunity to present evidence and argument to the
reviewer about why the procedure was unwarranted. The record of the
administrative review of the use of a restrictive procedure must state
whether:
A. the required documentation
was recorded;
B. the restrictive
procedure was used in accordance with the treatment plan;
C. the rule standards governing the use of
restrictive procedures were met; and
D. the staff who implemented the restrictive
procedure were properly trained.
Subp. 11.
Review of patterns of use of
restrictive procedures.
At least quarterly, the license holder must review the
patterns of the use of restrictive procedures. The review must be done by the
license holder or the facility's advisory committee. The review must
consider:
A. any patterns or problems
indicated by similarities in the time of day, day of the week, duration of the
use of a procedure, individuals involved, or other factors associated with the
use of restrictive procedures;
B.
any injuries resulting from the use of restrictive procedures;
C. actions needed to correct deficiencies in
the program's implementation of restrictive procedures;
D. an assessment of opportunities missed to
avoid the use of restrictive procedures; and
E. proposed actions to be taken to minimize
the use of physical holding and seclusion.
Statutory Authority:
L
1995 c 226 art 3
s
60; MS s
241.021;
245A.03;
245A.09
