Current through all regulations passed and filed through September 16, 2024
(A) For purposes of
this rule:
(1)
"Attending physician" means the
physician with the most significant role in the determination and delivery of
medical care to the individual at the time of a restraint order, which may
include, the resident's physician, the medical director of the home, or another
physician on the staff of the home.
(2)
"Prone restraint"
means all items or measures used to limit or control the movement or normal
functioning of any portion, or all, of an individual's body while the
individual is in a face-down position for an extended period of time. Prone
restraint includes physical or mechanical restraint.
(3)
"Transitional hold" means a brief physical positioning of an individual
facedown for the purpose of quickly and effectively gaining physical control of
that individual in order to prevent harm to self and others, or prior to
transport to enable the individual to be transported safely.
(B) Except as provided in
paragraph (F) of this rule for emergency situations, the nursing home shall not
physically or chemically restrain a resident or subject a resident to prolonged
isolation except on written order of
an attending physician which shall include the
date, means of restraint to be used, medical reason for restraint, and duration
of restraint. Such written orders shall be made a part of the resident's
record.
(1) The nursing home shall not use a
physical or chemical restraint or isolation for punishment, incentive, or
convenience.
(2) The use of prone
restraints and transitional holds is prohibited in nursing homes.
(3) A nursing home's use of the following for
the purposes stated in this paragraph shall not be construed as physically or
chemically restraining a resident or subjecting a resident to prolonged
isolation:
(a) Devices that assist a resident
in the improvement of the resident's mental and physical functional status and
that do not restrict freedom of movement or normal access to one's
body;
(b) Medications that are
standard treatment or a documented exception to standard treatment for the
resident's medical or psychiatric condition which assist a resident in
attaining or maintaining the resident's highest practicable physical, mental,
and psycho-social well-being; and
(c) Placement of residents in a unit who are
assessed to need specialized care that restricts their freedom of movement
throughout the home if:
(i) The home has made
the determination to place each resident in such unit in accordance with
paragraph (C) of this rule;
(ii)
Care and services are provided in accordance with each resident's individual
needs and preferences, not for staff convenience;
(iii) The need for the resident to remain in
the locked unit is reviewed during each periodic assessment required by
paragraph (F) of rule
3701-17-10 of the Administrative
Code and during the continuing care planning required by rule
3701-17-14 of the Administrative
Code;
(iv) The locked unit meets
the requirements of the state building and fire codes; and
(v) Residents who are not cognitively
impaired are able to enter and exit the unit without assistance.
(C) Except
as provided in this paragraph, and paragraph (F) of this rule for emergency
situations, prior to authorizing the use of a physical or chemical restraint on
any resident, the nursing home shall ensure that the attending physician:
(1) Makes a personal examination of the
resident and an individualized determination of the need to use the restraint
on that resident; and
(2) In
conjunction with an interdisciplinary team of health professionals and other
care givers, conducts an individualized comprehensive assessment of the
resident. This assessment shall:
(a) Identify
specific medical symptoms that warrant the use of the restraint;
(b) Determine the underlying cause of the
medical symptom and whether that underlying cause can be mitigated;
(c) Investigate and determine if possible
alternative interventions have been attempted and found unsuccessful. Determine
the least restrictive device that is most appropriate to meet the needs of the
resident, taking into consideration any contraindications;
(d) Discuss with the resident or authorized
representative, and any other individual designated or authorized by the
resident, the risks and benefits of the restraint; and
(e) Obtain written consent from the resident
or the resident's authorized representative.
A nursing home may restrain or isolate a resident transferred
from another health care facility based on the resident's transfer orders if
such orders include restraint use or isolation authorization and the home
complies with the provisions of this paragraph within twenty-four hours of the
resident's admission or readmission to the home.
(D) If a physical restraint is
ordered, the nursing home shall select the restraint appropriate for the
physical build and characteristics of the resident and shall follow the
manufacturer's instructions in applying the restraint. The nursing home shall
ensure that correct application of the restraint is supervised by a nurse and
that the restrained resident is monitored every thirty minutes. The visual
monitoring of the restrained resident may be delegated as permitted under state
law. Jackets, sheets, cuffs, belts, or mitts made with unprotected elements of
materials such as heavy canvas, leather, or metal shall not be used as
restraints.
(E) The attending
physician or a staff physician may authorize continued use of physical or
chemical restraints for a period not to exceed thirty days and, at the end of
this period and any subsequent period, may extend the authorization for an
additional period of not more than thirty days. The use of physical or chemical
restraints shall not be continued without a personal examination of the
resident and the written authorization of the attending physician stating the
reasons for continuing the restraint.
(F) Physical or chemical restraints or
isolation may be used in an emergency situation without authorization of, or
personal examination by, the attending physician only to protect the resident
from injury to self or others. Use of the physical or chemical restraint or
isolation shall not be continued for more than twelve hours after the onset of
the emergency without personal examination and authorization by the attending
physician.
(G) When isolation or
confinement is used, the nursing home shall ensure that:
(1) The resident is continually monitored and
periodically reassessed for continued use and need of this method of
intervention;
(2) The door is
secured in such a way as to be readily opened in case of an
emergency;
(3) The resident is
isolated or confined for the least amount of time to achieve desired
outcome.
(H) Members of
the nursing home's quality assurance committee, required by rule
3701-17-06 of the Administrative
Code, shall review monthly the use of restraints and isolation and any
incidents that resulted from their use, as well as incidents which resulted in
the use of restraints or isolation. The review shall identify any trends,
increases, and problems, the need for additional training, consultations or
corrective action which shall be discussed and reflected in the minutes of the
next quality assurance committee meeting.
