Current through Register Vol. 46, No. 12, March 20, 2024
(a) Physical restraints. Permissible physical
restraints, consisting solely of handcuffs and footcuffs, shall be used only in
cases where a child is uncontrollable and constitutes a serious and evident
danger to himself or others. They shall be removed as soon as the child is
controllable. Use of physical restraints shall be prohibited beyond one-half
hour unless a child is being transported by vehicle and physical restraint is
necessary for public safety. If restraints are placed on a child's hands and
feet, the hand and foot restraints are not to be joined, as for example, in hog
tying. When in restraints, a child may not be attached to any furniture or
fixture in a room nor to any object in a vehicle.
(1) The division shall prohibit the
utilization of foot manacles.
(2)
Physical restraints may be utilized beyond one-half hour only in the case of
vehicular transportation where such utilization of physical restraints is
necessary for public safety.
(b) Medical restraint. For the purposes of
this Part, medical restraint shall mean medication administered either by
injection or orally for the purposes of quieting an uncontrollable child.
(1) Medical restraint shall be administered
only in situations where a child is so uncontrollable that no other means of
restraint can prevent the child from harming himself.
(2) Medical restraint shall be authorized
only by a physician and be administered only by a registered nurse or a medical
doctor.
(c) Prn orders
of psychiatric medication. A pro re nata order, authorizing a registered nurse
to administer prescribed psychiatric medication, for purposes of crisis
intervention, may be used by the Division for Youth pursuant to the following
guidelines:
(1) Prescription by medical
doctor. Before any Prn order may be prescribed, a medical doctor must examine
the child and determine the need for such an order in terms of the individual
child's ongoing treatment needs at the facility. These Prn orders shall be
prescribed on an individual basis and shall not be prescribed pro forma to all
children at the time of their arrival at a facility, as follows:
(i) The medical doctor must sign the order
and the medical doctor must provide specific instructions and guidelines for
the nurse.
(ii) Periodic review of
all Prn orders must be made by a medical doctor, monthly, including physically
examining the child.
(iii) At the
time of the periodic review, the medical doctor must indicate, in writing,
reasons for his continuing the Prn order.
(2) Administration by registered nurse. A
registered nurse may administer a Prn order when the actions of the child
clearly present a danger to himself or other residents, as follows:
(i) She must physically examine the child and
refer to the child's medical record including the specific instructions left by
the medical doctor for utilization of the Prn order.
(ii) The pulse and blood pressure of children
receiving such medication must be taken during the first half hour by the nurse
and periodically thereafter until his release.
(iii) The nurse must keep a record indicating
the results of those examinations and shall prepare a medication report
indicating reasons giving rise to her dispensing the medication.
(iv) If the initial or subsequent examination
by the nurse reveals the development of any symptoms indicating an adverse
reaction to the medication, she shall immediately notify the medical
doctor.
(d)
Reporting requirements. Use of physical and medical restraints shall be
reported, pursuant to subdivision (j) of section
168.2
of this Part.