Current through Register Vol. 63, No. 9, September 1, 2024
(1) Subject to the
provisions of these rules, restraint may be used to manage the behavior of a
patient in emergencies. An emergency exists, as determined by the chief medical
officer or designee if, because of the behavior of a patient:
(a) There is a substantial likelihood of
immediate physical harm to the patient or others in the institution;
or
(b) The patient's behavior
seriously disrupts the activities of other patients on the unit or cottage;
or
(c) Measures other than the use
of restraint are deemed ineffective to manage the behavior.
(2) When an emergency exists:
(a) The staff of a state institution shall
select the most appropriate intervention consistent with OAR
309-112-0010(9);
(b) Whenever the interdisciplinary team (IDT)
has reason to believe that in the course of a patient's care, custody, or
treatment at a state institution it may become necessary to use restraint in an
emergency, a member of the IDT shall, if practicable, ask the patient for an
expression of preference or aversion to the various forms of intervention. A
member of the IDT shall also ask the parent or guardian for an expression of
preference regarding forms of intervention. The patient's expression, if any,
as well as that of the parent or guardian shall be relayed to the other IDT
members and recorded in the patient's chart;
(c) The patient's wishes for or against
particular forms of intervention shall be respected by the person authorizing
the use of restraint, provided that primary consideration shall be given to the
need to protect the patient and others in the institution.
(3) Authorization:
(a) Except as provided in subsections (3)(d)
and (e) of this rule, restraint shall be administered only pursuant to the
order of the chief medical officer or the chief medical officer's
designee;
(b) For the purposes of
this section, the chief medical officer may designate one or more of the
following persons: A physician licensed to practice medicine in the State of
Oregon, a psychologist, or a psychiatric/mental health nurse
practitioner;
(c) The chief medical
officer or designee shall order the use of restraint only after adequately
assessing the patient's condition and the environmental situation;
(d) If the chief medical officer or designee
is not available immediately to assess the need for intervention, and an
emergency exists as defined in section (1) of this rule:
(A) The person in charge of the unit or
cottage at the time:
(i) May authorize
temporary use of restraint for a period of time not to exceed 30 minutes;
and
(ii) Shall immediately contact
the chief medical officer or his or her designee.
(B) The chief medical officer or designee
shall personally observe the patient as soon as practicable to assess the
patient and assess the appropriateness of the temporary use of restraint. The
observation shall be documented in the person's chart.
(e) Every incident of personal restraint must
be ordered by the chief medical officer or their designee, or as provided in
subsection (3)(d) of this rule. The order may be oral or written but shall be
documented as provided in section (4) of this rule.
(4) Documentation:
(a) No later than the end of their work
shifts, the persons who authorized and carried out the use of restraint shall
document in the patient's chart including but not necessarily limited to:
(A) The specific behavior which required
intervention;
(B) The method of
intervention used and the patient's response to the intervention; and
(C) The reason this specific intervention was
used.
(b) Within 24
hours after the incident resulting in the use of restraint, the chief medical
officer or designee who ordered the intervention shall review and sign the
documentation. In the case of patients detained in a psychiatric hospital
pursuant to an emergency hold under ORS
426.180 through
426.225, the treating physician
shall sign the documentation, if the treating physician is not the chief
medical officer or designee who ordered the intervention.
(5) Time Limits: All orders authorizing use
of restraint shall contain an expiration time, not to exceed 12 hours and
consistent with OAR 309-112-0010(8).
Upon personal re-examination of the patient, the chief medical officer or
designee may extend the order for up to 12 hours at each review, provided that
the behavior of the patient justifies extended intervention. After each 24
hours of continuous restraint, a second opinion from another designee of the
chief medical officer shall be required for further extension of the
restraint.
(6) Reporting: Under
this rule all emergency uses of restraint in excess of 15 minutes shall be
reported daily to the chief medical officer or designee.
(7) After the second use of emergency
restraint on a particular patient during a one-month period, a treatment
program designed to reduce the need for restraint must be developed.
Statutory/Other Authority: ORS
179.040 &
413.042
Statutes/Other Implemented: ORS
426.385
