Current through Register Vol. 49, No. 13, September 23, 2024
Subpart 1.
Behavior management.
Disciplinary restrictions, emergency seclusion, and
protective isolation may be imposed in accordance with this part when necessary
to ensure a safe, secure, and orderly environment for the treatment program.
For purposes of this part, disciplinary restrictions, emergency seclusion, and
protective isolation have the meanings in subparts
2 to
4.
Subp. 2.
Disciplinary
restrictions.
"Disciplinary restrictions" means withholding or limiting
privileges otherwise available to a person in treatment as a consequence of the
person's violating rules of behavior. Examples of disciplinary restrictions
would include withholding or limiting such privileges as work, leisure,
vocational and recreational activities, or access to parts of the facility.
Disciplinary restrictions must:
A. be
in proportion to the rule's importance to the order, safety, and security of
the treatment program and to the severity of the violation;
B. be reasonably related to the nature of the
behavior; and
C. take into
consideration the person's past behavior while in the program.
Subp. 3.
Emergency
seclusion.
"Emergency seclusion" means an emergency intervention that
physically separates the person in treatment from others, including placing the
person in a room from which the person is not able or permitted to exit.
Emergency seclusion does not include locking a person in the person's sleeping
room during normal sleeping hours or limiting a person's access to parts of the
facility to which the person would otherwise have access. Emergency seclusion
must be:
A. imposed only when
necessary to protect the person being secluded or another person or individual
from imminent danger of serious physical harm or to prevent serious property
damage;
B. authorized by the nurse
on duty who must immediately contact a physician for an order; and
C. continued only as long as the person's
behavior indicates imminent danger continues.
Staff must monitor the person in emergency seclusion no less
than every 15 minutes. A physician must review the situation at least every 24
hours.
Subp. 4.
Protective isolation.
"Protective isolation" means placing a person in treatment in
a room from which the person is not able or permitted to exit as a way of
defusing or containing dangerous behavior that is uncontrollable by any other
means.
The license holder must have written policies on protective
isolation that cover the points in items A to C.
A. Protective isolation must not be used for
the convenience of staff or as a substitute for programming.
B. Treatment must be available during
protective isolation to the extent that the person's behavior and condition
make treatment possible; treatment shall include components designed to
eliminate or reduce the specified behavior or behaviors that caused the need
for protective isolation.
C.
Protective isolation must not go beyond 48 continuous hours unless the
treatment team recommends continuation to the medical director in a statement
that:
(1) explains why continued protective
isolation is necessary;
(2)
contains an objective description of the behavior which poses the
danger;
(3) describes the frequency
with which the behavior has occurred in the past;
(4) analyzes the causes or precipitating
condition for the behavior including, where appropriate, an analysis of the
needs of the person which may cause the behavior;
(5) discusses why protective isolation is
necessary, including a statement of the facts and data from which it is
concluded that less restrictive programming will not be sufficient to prevent
harm;
(6) describes the treatment
plan, if any, which will be offered during the period of protective
isolation;
(7) sets forth a plan
for reviewing the protective isolation, including the frequency of reviews and
the criteria for determining that the risk of harm is no longer sufficient to
justify isolation; and
(8) is
placed in the medical records of the person in protective isolation.
Continuing protective isolation is contingent on the medical
director's written approval of the recommendation. If the plan for continuing
protective isolation is approved, staff must follow the plan required in
subitem (7).
Subp.
5.
Request for review of protective isolation.
The license holder must provide to a person in treatment who
is placed in protective isolation a procedure which can be used immediately to
request a review if the person believes the placement was unwarranted.
Protective isolation may be imposed pending the outcome of the review. The
review request procedure must include the elements in items A to D.
A. The review must be conducted by a panel of
at least three persons, who were not participants in the decision to impose the
isolation, and whose professional experience and training qualify them to
assess the situation.
B. The review
must be conducted and the outcome determined within seven days of being
requested, excluding Saturdays, Sundays, and legal holidays, unless the review
panel states in writing why a determination cannot be made within seven days
and specifies when a determination will be made.
C. The person requesting the review must have
the opportunity to present to the review panel evidence and argument to explain
why protective isolation is unwarranted. The review panel may reasonably limit
the form by which the evidence and argument are presented if necessary to
ensure the physical safety of the review participants.
D. A person may request that the chief
officer of the facility review a determination of the review panel. The chief
officer's decision is final.
Statutory Authority: MS s
246B.04
