Administrative Rules of Montana
Department 37 - PUBLIC HEALTH AND HUMAN SERVICES
Chapter 37.106 - HEALTH CARE FACILITIES
Subchapter 37.106.16 - Minimum Standards for a Forensic Mental Health Facility
Rule 37.106.1617 - RESTRAINT AND SECLUSION

(1) A forensic mental health facility (FMHF) must be capable of providing restraint or seclusion and must ensure that such restraint or seclusion is performed in compliance with 53-21-146, MCA.

(2) The use of medication solely for restraint is prohibited.

(3) Restraint or seclusion may only be used when less restrictive interventions have been determined to be ineffective to protect the client, staff, or others from harm.

(4) The type and technique of restraint or seclusion must be the least restrictive intervention that will be effective to protect the client, staff, or others from harm.

(5) The use of restraint or seclusion must be implemented in accordance with safe and appropriate restraint and seclusion techniques as determined by facility policy.

(6) Orders for the use of restraint or seclusion must never be written as a standing order or on an as-needed basis (PRN).

(7) A verbal or written order must be obtained from the licensed health care practitioner prior to initiation or as soon as possible after emergency initiation of seclusion or restraint.

(8) A licensed health care practitioner or registered nurse, in accordance with facility policy, must see the client face-to-face within one hour of the initiation of restraint or seclusion to evaluate:

(9) Each original order and renewal order authorizing the use of restraint or seclusion is limited to eight hours, up to a total of 24 hours. After 24 hours and before writing a new order, a licensed health care practitioner must see and assess the client.

(10) Staff must provide clients in restraint or seclusion with constant in-person observation for the first hour; after the first hour in-person observation can be replaced by audio and visual equipment according to facility policy.

(11) Restraint or seclusion must be discontinued at the earliest possible time, regardless of the length of time identified in the order.

(12) A licensed health care professional must monitor the condition of the client who is restrained or secluded at an interval determined by facility policy.

(13) Each incident of restraint or seclusion must be documented in the client's medical record and must include:

(14) Staff must be trained and able to demonstrate competency in the application of restraints, implementation of seclusion, monitoring, assessment, and providing care for a client in restraint or seclusion. The training must include:

(15) Staff must receive training prior to performing any actions specified in this rule and annually thereafter.

(16) An FMHF must document in the staff personnel records that training and demonstration of competency was successfully completed.

(17) The use of simultaneous restraint and seclusion is prohibited.