Current through Register No. 40, October 3, 2024
(a) For CMS
certified nursing homes, the use of restraints shall be permitted as allowed by
42
CFR 483.12(a) .
(b) For all other facilities, the
requirements in (c) through (g) shall apply.
(c) When physical restraints are used, the
following requirements shall be met:
(1)
Physical restraints shall be used only after less restrictive measures have
been found to be ineffective to protect the resident or others from
harm;
(2) Except as allowed in (d)
below, physical restraints shall be ordered for a specified and limited time by
a licensed practitioner; and
(3)
The order for the physical restraints in (2) above may be verbal and shall:
a. Be obtained by a licensed nurse before the
physical restraint is administered; and
b. Be followed with the licensed
practitioner's signature within 14 days.
(d) In an emergency situation, physical
restraints may be authorized by a professional staff member designated by the
licensee in accordance with established policy and procedure under
He-P 803.15(p) (3)
as follows:
(1) The designated staff member shall
promptly report the restraint use and the resident's behavior to the resident's
licensed practitioner; and
(2) The
designated staff member shall document the use of restraints in the resident's
clinical record, in accordance with (g) below.
(e) When chemical restraints are used, the
following requirements shall be met:
(1)
Chemical restraints shall be used only after less restrictive measures have
been found to be ineffective to protect the resident or others from
harm;
(2) Chemical restraints shall
be ordered for a specified and limited time by a licensed
practitioner;
(3) The order for the
chemical restraints can be verbal and shall:
a. Be obtained by a licensed nurse before the
chemical restraint is administered; and
b. Be followed with the licensed
practitioner's signature within 14 days;
(4) Medication used as a chemical restraint
may only be administered by a licensed nurse or licensed
practitioner;
(5) Standing orders
for medications utilized as chemical restraints shall be prohibited;
and
(6) It shall be the
responsibility of the licensed nurse or licensed practitioner administering the
chemical restraint to document the administration of the medication and the
effects as specified in
He-P 803.16(y) and (ac)
.
(f) When mechanical restraints are used, the
following requirements shall be met:
(1)
Mechanical restraints shall be used only when less restrictive measures have
been found to be ineffective in protecting the resident or others from
harm;
(2) Mechanical restraints
shall be ordered for a specific and limited time by a licensed practitioner and
the order shall include:
a. The type of
restraint to be used;
b. The reason
for the restraint; and
c. The time
intervals at which the licensee's personnel shall check the resident's
well-being and the placement and position of the restraint;
(3) Standing orders for the use of
mechanical restraints shall be prohibited;
(4) Mechanical restraints shall not be
applied in a manner that impedes circulation; and
(5) Locked, secured or alarmed doors or
elevators, or units within a nursing home, anklets, bracelets and similar
devices that cause a door to automatically lock when approached, thereby
preventing a resident from freely exiting the nursing home or unit within shall
not be considered restraints provided they meet the requirements of the
applicable building and fire safety codes and are documented in the care
plan.
(g) The use of all
restraints shall be documented in the resident's clinical record according to
the licensee's policy, including:
(1) The
behavior and actions of the resident that necessitated the use of a
restraint;
(2) The authorization
given to restrain the resident;
(3)
The type of restraint used;
(4) The
length of time the resident was restrained;
(5) The effects of the restraint on the
resident;
(6) The report to the
resident's licensed practitioner and all actions taken; and
(7) Any orders from the resident's licensed
practitioner.
#9856-A, eff
1-26-11
