Current through Vol. 42, No. 7, December 16, 2024
(a)
All PRTFs must comply with the condition of participation for restraint or
seclusion, as is established by
42 C.F.R. §§
483.350 through
483.376,
which is hereby incorporated by reference in its entirety. All general and
psychiatric hospitals must comply with the standard for restraint or seclusion,
as is established by
42 C.F.R. §
482.13(e) - (g), which is
hereby incorporated by reference in its entirety. In the case of any
inconsistency or duplication between these federal regulations and OAC
317:30-5-95.39, the federal regulations shall prevail, except where OAC
317:30-5-95.39 and/or other Oklahoma law is more protective of a member's
health, safety, or well-being.
(b)
Restraint or seclusion may only be used when less restrictive interventions
have been determined to be ineffective to protect the member, a staff member,
or others from harm and may only be imposed to ensure the immediate physical
safety of the member, a staff member, or others. The use of restraint or
seclusion must be in accordance with a written modification to the member's
individual plan of care. The type or technique of restraint or seclusion used
must be the least restrictive intervention that will be effective to protect
the member or others from harm. Restraint or seclusion must be discontinued at
the earliest possible time, regardless of the length of time identified in the
order. Mechanical restraints will not be used on children under age eighteen
(18).
(1) Each facility must have policies
and procedure to describe the conditions in which restraint or seclusion would
be utilized, the behavioral/management intervention program followed by the
facility, and the documentation required. Restraint or seclusion may only be
ordered by the following individuals trained in the use of emergency safety
interventions: a Physician; a Physician Assistant (PA); or an Advanced Practice
Registered Nurse (APRN) with prescriptive authority. If, however, the member's
treatment team physician is available, then only he or she can order restraint
or seclusion. Each order for restraint or seclusion may only be renewed in
accordance with the following limits for up to a total of twenty-four (24)
hours:
(A) four (4) hours for adults eighteen
(18) to twenty-one (21) years of age;
(B) two (2) hours for children and
adolescents nine (9) to seventeen (17) years of age; or
(C) one (1) hour for children under nine (9)
years of age.
(2) An
order for the use of restraint/seclusion must never be written as a standing
order or on an as-needed basis.
(3)
The documentation required to ensure that restraint or seclusion was
appropriately implemented and monitored will include, at a minimum:
(A) documentation of events leading to
intervention used to manage the violent or self-destructive behaviors that
jeopardize the immediate physical safety of the member or others;
(B) documentation of alternatives or less
restrictive interventions attempted;
(C) a signed order for restraint/seclusion
that includes the name of the individual ordering the restraint/seclusion, the
date and time the order was obtained, and the length of time for which the
order was authorized;
(D) the time
the restraint/seclusion actually began and ended;
(E) the name of staff involved in the
restraint/seclusion;
(F)
documentation sufficient to show the member was monitored in accordance with
42 C.F.R. §
482.13(e) (for general and
psychiatric hospitals) or
42
C.F.R. §§
483.362 and
483.364
(for PRTFs), as applicable;
(G) the
time and results of a face-to-face assessment completed within one (1) hour
after initiation of the restraint/seclusion by a Physician, PA, APRN with
prescriptive authority, or Registered Nurse, who has been trained in the use of
emergency safety interventions. The assessment must evaluate the member's
well-being, including those criteria set forth in
42 C.F.R. §
482.13(e) (for general and
psychiatric hospitals) or
42 C.F.R. §
483.358(f) (for PRTFs), as
applicable;
(H) in the event the
face-to-face assessment was completed by anyone other than the member's
treatment team physician, documentation that he or she consulted the member's
treatment team physician as soon as possible after completion of the
face-to-face assessment;
(I)
debriefing of the child and staff involved in the emergency safety intervention
within twenty-four (24) hours, in accordance with
42 C.F.R. §
483.370, as applicable;
(J) debriefing of all staff involved in the
emergency safety intervention and appropriate supervisory and administrative
staff within twenty-four (24) hours, in accordance with
42 C.F.R. §
483.370, as applicable; and
(K) for minors, notification of the
parent(s)/guardian(s).
(c) Serious occurrences, including death,
serious injury, or suicide attempt, must be reported as follows:
(1) In accordance with
42 C.F.R. §
483.374, PRTFs must notify the OHCA
Behavioral Health Unit and Oklahoma Department of Human Services (DHS) by phone
no later than 5:00 p.m. on the business day following a serious occurrence and
disclose, at a minimum: the name of the member involved in the serious
occurrence; a description of the occurrence; and the name, street address, and
telephone number of the facility.
(A) Within
three (3) days of the serious occurrence, a PRTF must also submit a written
Facility Critical Incident Report to the OHCA Behavioral Health Unit
containing: the information in OAC 317:30-5-95.39(c)(1), above; and any
available follow-up information regarding the member's condition, debriefings,
and programmatic changes implemented (if applicable). A copy of this report
must be maintained in the member's record, along with the names of the persons
at OHCA and DHS to whom the occurrence was reported. A copy of the report must
also be maintained in the incident and accident report logs kept by the
facility.
(B) In the case of a
minor, the PRTF must also notify the member's parent(s) or legal guardian(s) as
soon as possible, and in no case later than twenty-four (24) hours after the
serious occurrence.
(2)
In addition to the requirements in paragraph (1), above, the death of any
member must be reported in accordance with
42 C.F.R. §
482.13(g) (hospital
reporting requirements for deaths associated with the use of seclusion or
restraint) or
42 C.F.R. §
483.374(c) (PRTF reporting
requirements for deaths), as applicable.
(d) In accordance with
42 C.F.R. §
483.374(a), OHCA requires
all PRTFs that provide SoonerCare inpatient psychiatric services to members
under age twenty-one (21) to attest in writing at the time of contracting, that
the facility is in compliance with all federal standards governing the use of
restraint and seclusion. The attestation letter must be signed by the facility
director, and must include, at a minimum:
(1)
the name, address, and telephone number of the facility, and its provider
identification number;
(2) the name
and signature of the facility director;
(3) the date the attestation is
signed;
(4) a statement certifying
that the facility currently meets all of the federal requirements governing the
use of restraint and seclusion;
(5)
a statement acknowledging the right of OHCA, CMS, and/or any other entity
authorized by law, to conduct an on-site survey at any time to validate the
facility's compliance with
42 C.F.R. §§
483.350 through
483.376,
to investigate complaints lodged against the facility, and to investigate
serious occurrences;
(6) a
statement that the facility will notify the OHCA if it is out of compliance
with
42 C.F.R. §§
483.350 through
483.376;
and
(7) a statement that the
facility will submit a new attestation of compliance in the event the facility
director changes, for any reason.
Added at 23 Ok Reg
2508, eff 6-25-06; Amended at 24 Ok Reg 2880, eff 7-1-07 (emergency); Amended
at 25 Ok Reg 1161, eff 5-25-08; Amended at 27 Ok Reg 2737, eff 7-20-10
(emergency); Amended at 28 Ok Reg 1452, eff
6-25-11
