(b) The state
facility director shall develop policies and procedures for those interventions
determined to be acceptable for use in the state facility. Such policies and
procedures shall include that:
(1) positive
alternatives and less restrictive alternatives are considered and used whenever
possible prior to the use of seclusion, physical restraint or isolation
time-out; and
(2) consideration is
given to the client's physical and psychological well-being before, during and
after utilization of a restrictive intervention, including:
(A) review of the client's health history or
the comprehensive health assessment conducted upon admission to a facility. The
health history or comprehensive health assessment shall include the
identification of pre-existing medical conditions or any disabilities and
limitations that would place the client at greater risk during the use of
restrictive interventions;
(B)
continuous assessment and monitoring of the physical and psychological
well-being of the client and the safe use of physical restraint throughout the
duration of the restrictive intervention by staff who are physically present
and trained in the use of emergency safety interventions;
(C) continuous monitoring of the client's
physical and psychological well-being by an individual trained in the use of
cardiopulmonary resuscitation during the use of manual restraint; and
(D) continued monitoring of the client's
physical and psychological well-being by an individual trained in the use of
cardiopulmonary resuscitation for a minimum of 30 minutes subsequent to the
termination of a restrictive intervention;
(3) procedures for ensuring that the
competent adult client or legally responsible person of a minor client or
incompetent adult client is informed in a manner he or she can understand:
(A) of the general types of intrusive
interventions that are authorized for use by the state facility; and
(B) that the legally responsible person can
request notification of each use of an intervention as specified in this Rule,
in addition to those situations required by
G.S.
122C-62;
(4) provisions for humane, secure and safe
conditions in areas used for the intervention, such as ventilation, light and a
room temperature consistent with the rest of the state facility;
(5) attention paid to the need for fluid
intake and the provision of regular meals, bathing and the use of the toilet.
Such attention shall be documented in the client record; and
(6) procedures for assuring that when an
intervention as specified in this Rule has been used with a client three or
more times in a calendar month, the following requirements are met:
(A) A treatment/habilitation plan shall be
developed within 10 working days of the third intervention. The
treatment/habilitation plan shall include, but not be limited to:
(i) indication of need;
(ii) specific description of problem
behavior;
(iii) specific goals to
be achieved and estimated duration of procedures;
(iv) specific early interventions to prevent
tension from escalating to the point of loss of control whenever
possible;
(v) consideration,
whenever possible, for client's preference for the type of physical restraint
to be used;
(vi) specific
procedure(s) to be employed;
(vii)
specific methodology of the intervention;
(viii) methods for measuring treatment
efficacy;
(ix) guidelines for
discontinuation of the procedure;
(x) the accompanying positive treatment or
habilitation methods which shall be at least as strong as the negative aspects
of the plan;
(xi) description and
frequency of debriefing, if determined to be clinically necessary;
(xii) specific limitations on approved uses
of the intervention per episode, per day and requirements for on-site
assessments by the responsible professional; and
(xiii) description of any requirements in
Rule .0206 of this Section to be incorporated into the plan;
(B) In emergency situations, with
the approval of the state facility director, the treatment/habilitation team
may continue to use the intervention until the planned intervention is
addressed in the treatment/habilitation plan;
(C) The treatment/habilitation team shall
explain the intervention and the reason for the intervention to the client and
the legally responsible person, if applicable, and document such explanation in
the client record;
(D) Before
implementation of the planned intervention, the treatment/habilitation team,
with the participation of the client and legally responsible person if
applicable, shall approve the treatment/habilitation plan and consent shall be
obtained as specified in Rule .0210(e) in this Section;
(E) The use of the intervention shall be
reviewed at least monthly by the treatment/habilitation team and at least
quarterly, if still in effect, by a designee of the state facility director.
The designee of the state facility director may not be a member of the client's
treatment/habilitation team. Reviews shall be documented in the client
record;
(F) Treatment/habilitation
plans which include these interventions shall be subject to review by the Human
Rights Committee in compliance with confidentiality rules as specified in
10A NCAC
28A;
(G) Each treatment/habilitation team shall
maintain a record of the use of the intervention. Such records or reports shall
be available to the Human Rights Committee and internal client advocate within
the constraints of
10A NCAC
26B .0209 and
G.S.
122C-53(g);
(H) The state facility director shall follow
the Right to Refuse Treatment Procedures as specified in Section .0300 of this
Subchapter; and
(I) The
interventions specified in this Rule shall never be the sole treatment modality
designed to eliminate the target behavior. The interventions are to be used
consistently and shall always be accompanied by positive treatment or
habilitation methods.
