Current through Register Vol. 49, No. 13, September 23, 2024
Subpart
1.
Use of protective procedures.
A. Protective procedures may be used only in
cases where a less restrictive alternative will not protect the client or
others from harm and when the client is in imminent danger of causing harm to
self or to others. The procedures must end when the client is no longer
dangerous.
B. Protective procedures
may not be used:
(1) for disciplinary
purposes;
(2) to enforce program
rules;
(3) for the convenience of
staff;
(4) as a part of any
client's health monitoring plan; or
(5) for any reason except in response to
specific current behaviors which threaten the safety of the client or
others.
Subp.
2.
Protective procedures plan.
A license holder and applicant must have a written plan that
establishes the protective procedures that program staff must follow when a
client's behavior threatens the safety of the client or others. The plan must
be appropriate to the type of facility and the level of staff training. The
protective procedures plan must include:
A. approval signed and dated by the program
director and medical director prior to implementation. Any changes to the plan
must also be approved, signed, and dated by the program director and the
medical director prior to implementation;
B. which protective procedures the license
holder will use to prevent clients from harming self or others;
C. the emergency conditions under which the
protective procedures are used, if any;
D. the client's health conditions that limit
the specific procedures that can be used and alternative means of ensuring
safety;
E. emergency resources the
program staff must contact when a client's behavior cannot be controlled by the
procedures established in the plan;
F. the training staff must have before using
any protective procedure;
G.
documentation of approved therapeutic holds; and
H. the use of law enforcement
personnel.
Subp. 3.
Records.
Each use of a protective procedure must be documented in the
client record. The client record must include:
A. a description of specific client behavior
precipitating a decision to use a protective procedure, including date, time,
and program staff present;
B. the
specific means used to limit the client's behavior;
C. the time the protective procedure began,
the time the protective measure ended, and the time of each staff observation
of the client during the procedure;
D. the names of the program staff authorizing
the use of the protective procedure and the program staff directly involved in
the protective procedure and the observation process;
E. the physician's order authorizing the use
of restraints as required by subpart
6;
F. a brief description of the purpose for
using the protective procedure, including less restrictive interventions
considered prior to the decision to use the protective procedure and a
description of the behavioral results obtained through the use of the
procedure;
G. documentation of
reassessment of the client at least every 15 minutes to determine if seclusion,
physical hold, or use of restraint equipment can be terminated;
H. the description of the physical holds or
restraint equipment used in escorting a client; and
I. any injury to the client that occurred
during the use of a protective procedure.
Subp. 4.
Standards governing emergency
use of seclusion.
Seclusion must be used only when less restrictive measures
are ineffective or not feasible. The standards in items A to G must be met when
seclusion is used with a client.
A.
Seclusion must be employed solely for the purpose of preventing a client from
harming self or others.
B.
Seclusion facilities must be equipped in a manner that prevents clients from
self-harm using projections, windows, electrical fixtures, or hard objects, and
must allow the client to be readily observed without being
interrupted.
C. Seclusion must be
authorized by the program director, a licensed physician, or registered nurse.
If one is not present in the facility, one must be contacted and authorization
obtained within 30 minutes of initiation of seclusion according to written
policies.
D. Clients must not be
placed in seclusion for more than 12 hours at any one time.
E. Clients in seclusion must be observed
every quarter hour for the duration of seclusion and must always be within
hearing range of program staff.
F.
Program staff must have a process for removing a client to a more restrictive
setting in the facility or have other resources available to the facility if
seclusion does not sufficiently assure client safety.
G. Seclusion areas may be used for other
purposes, such as intensive observation, if the room meets normal standards of
care for the purpose and if the room is not locked.
Subp. 5.
Physical holds or restraint
equipment.
Physical holds or restraint equipment may only be used in
cases where seclusion will not assure the client's safety and must meet the
requirements in items A to C.
A. The
following requirements apply to the use of physical holds or restraint
equipment:
(1) a physical hold cannot be used
to control a client's behavior for more than 30 minutes before obtaining
authorization;
(2) the client's
health concerns will be considered in deciding whether to use physical holds or
restraint equipment and which holds or equipment are appropriate for the
client;
(3) the use of physical
holds or restraint equipment must be authorized by the program director,
licensed physician, or a registered nurse;
(4) only approved holds may be utilized;
and
(5) the use of restraint
equipment must not exceed four hours.
B. Restraint equipment must be designed,
used, and maintained to ensure client protection from self-harm with minimal
discomfort.
C. A client in
restraint equipment must be checked for circulatory difficulties every 15
minutes. Restraint equipment must be loosened at least once every 60 minutes to
allow change of position unless loosening the restraints would be dangerous to
the client or others. If the restraint equipment is not loosened every hour,
the client's behavior that prevented loosening the restraints must be
documented in the client's file.
Subp. 6. [Repealed, 32 SR 2268]
Subp. 7. [Repealed, 32 SR 2268]
Subp. 8.
Use of law enforcement.
A. Law enforcement shall only be called for a
violation of the law by a client.
B. If a law enforcement agent uses any force
or protective procedure which is not specified in the protective procedures
plan for use by trained staff members the client must be discharged, according
to part
9530.6525, subpart
4.
Subp. 9.
Administrative review.
The license holder must keep a record of all protective
procedures used and conduct a quarterly administrative review of the use of
protective procedures. The record of the administrative review of the use of
protective procedures must state whether:
A. the required documentation was recorded
for each use of a protective procedure;
B. the protective procedure was used
according to the protective procedures plan;
C. the staff who implemented the protective
procedure were properly trained;
D.
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 protective procedures;
E. any injuries resulting from the use of
protective procedures;
F. actions
needed to correct deficiencies in the program's implementation of protective
procedures;
G. an assessment of
opportunities missed to avoid the use of protective procedures; and
H. proposed actions to be taken to minimize
the use of protective procedures.
Statutory Authority: MS s
241.021;
245A.03;
245A.09;
254A.03;
254B.03;
254B.04
