Current through Register Vol. 39, No. 6, September 16, 2024
(a) Restraint shall
be used only under the following circumstances:
(1) after less restrictive measures, such as
counseling and seclusion, have been attempted or if clinically determined to be
inappropriate or inadequate to avoid injury to self or others; and
(2) either:
(A) upon the order of a clinician to control
a client who has attempted, threatened, or accomplished harm to himself or
others; or
(B) upon the
authorization of the officer-in-charge on an emergency basis if believed
necessary to prevent immediate harm to the client or to others.
(3) In determining if restraint is
indicated, a clinician shall consider whether the client:
(A) has inflicted an injury to himself or to
others and, if so, the nature and extent of such injury; or
(B) threatens, through words or gestures, to
inflict injury to himself or others and the nature of the threat.
(b) When a client
exhibits behavior indicating the use of restraints and under the conditions of
Paragraph (a) of this Rule, the following procedures shall be followed:
(1) If, in the judgment of any staff member,
immediate restraint is necessary to protect the client or others, the client
shall be referred immediately to a clinician for observation and
treatment.
(2) If there is
insufficient time to make the referral or if a clinician is not immediately
available:
(A) the staff in charge may employ
emergency use of restraint;
(B) the
client shall be reviewed within four hours of the initial restraint, and a
restraint may be ordered by a clinician pursuant to Paragraph (a) of this Rule.
This may be accomplished by:
(i) telephone
contact between the senior health professional at the facility and the
clinician; and
(ii) if such review
cannot be obtained, the client shall be released from restraint.
(C) a restraint order shall not
exceed four hours. At the expiration of the restraint order, the client shall
be released from restraint unless a new order is issued; and
(D) a subsequent order for continuing
restraint shall be based on:
(i) the client's
present condition and behavior; and
(ii) reasons other than the original reasons
for restraint, unless the order indicates the original reasons are considered
applicable at the time of the subsequent order.
(c) If the client is restrained
and subject to injury by another client, a professional staff member shall
remain continuously present with the client. Observations and interventions
shall be documented in the client record.
(d) All orders for continuation of restraint
shall be reviewed and documented in intervals not to exceed four hours
thereafter, either by personal examination or telephone communication between
health professionals and the responsible clinician.
(e) All orders of restraint issued or
approved by a clinician shall include written authorization to correctional
staff or health professionals to release the client when he or she is no longer
dangerous to him or herself or to others.
(f) The responsible clinician shall be
notified upon release of a client from restraint.
(g) Observations or reviews of all clients in
restraint shall be made as follows:
(1)
observations no less frequently than every 30 minutes;
(2) observations every four hours by the
responsible clinician either personally or through reports from health
professionals; and
(3) reviews by
an internal committee in accordance with Paragraph (h) of this Rule.
(h) Committee review: An internal
committee consisting of three members of the Department's clinical and
administrative staff, including at least one psychologist and one psychiatrist
shall review cases in which restraints were used beyond four hours. The
incident will be reviewed and include consideration of the following:
(1) the use of appropriate procedures in the
decision to restrain;
(2)
sufficient indications for the use of restraint; and
(3) release of the client from restraint as
soon as clinically indicated based upon consideration of the factors listed in
Paragraphs (a) and (b) of this Rule.
(i) When a client is placed in restraint, the
client record shall contain documentation of the following:
(1) the rationale and authorization for the
use of restraint, including placement in restraint pending review by the
responsible clinician;
(2) a record
of the observations of the client as required by Paragraph (g) of this
Rule.
(3) each review by the
responsible clinician as required by this Rule, including a description of the
client and all significant changes that have occurred; and
(4) each review by the internal committee as
required in Paragraph (h) of this Rule.
Authority
G. S.
148-19(d);
Eff.
January 4, 1994;
Readopted Eff. March 1,
2019.
