Pennsylvania Code
Title 55 - HUMAN SERVICES
Part I - Department of Human Services
Subpart B - Rights
Chapter 13 - USE OF RESTRAINTS IN TREATING PATIENTS/RESIDENTS
Section 13.8 - Seclusion
Universal Citation: 55 PA Code ยง 13.8
Current through Register Vol. 54, No. 44, November 2, 2024
(a) Definition.
(1)
Seclusion.
(i) The placement
of a patient/resident in a locked room may be used as a therapeutic technique
only.
(ii) The patient's/resident's
request to spend time in a private unlocked room is not to be considered
seclusion and shall be granted if feasible and not therapeutically contra
indicated. Quarantine or other preventive health measures are not considered
seclusion.
(iii) In mental health
facilities children under 14 years of age requiring seclusion shall be
continuously monitored within or just outside the seclusion area by mental
health personnel, and the room shall not be locked or otherwise secured. Soft
inanimate objects shall be made available to the patient to permit the venting
of aggression.
(iv) Seclusion shall
be used only under the following conditions:
(A) When necessary to protect the
patient/resident or others from physical injury.
(B) To decrease the level of stimulation when
a patient/resident is in a state of hyperactivity.
(C) When less restrictive measures and
techniques have proven ineffective.
(D) Seclusion as defined in this paragraph
may not be employed in a State center for individuals with an intellectual
disability.
(2)
Exclusion. Within mental health/intellectual disability
facilities the removing of the patient/resident from his immediate environment
and restricting him to another area. Exclusion shall only be employed when it
is clearly documented that another less restrictive method has been
unsuccessful in controlling the unacceptable behavior. Exclusion shall be
limited and documented as a therapeutic technique in the resident's individual
treatment plan. In mental health facilities children under 14 years of age
requiring seclusion or exclusion shall be continuously monitored within or just
outside the exclusion area by mental health personnel, and the room may not be
locked or otherwise secured. Soft inanimate objects shall be made available to
the patient to permit the venting of aggression.
(b) Procedures.
(1) In mental health facilities if a
patient/resident in voluntary treatment requires seclusion, will not consent to
such and requests to be discharged, this request shall be granted unless the
procedures and standards of section 302 of the Mental Health Procedures Act
(50
P.S. §
7302) regarding emergency
involuntary treatment and §
5100.76 (relating to notice of
withdrawal) are followed. Similarly, the procedures of section 405 of the
Mental Health and Intellectual Disability Act of 1966 (50 P.S. §
4405) shall be followed for persons with an
intellectual disability who have been voluntarily admitted, require seclusion,
and request to be discharged.
(2)
In the case of mental health facilities, authority for seclusion of a
patient/resident rests with the Director or his designee. In intellectual
disability facilities, authority for exclusion rests with the qualified
intellectual disability professional. In the case of Youth Development Centers,
Youth Forestry Camps and all other Departmental institutions authority for
seclusion rests with the Superintendent/Assistant Superintendent. Normally,
written orders shall precede the placement of a patient/resident in seclusion
or exclusion. In emergencies, telephone orders may be accepted, but an order
shall be properly countersigned within the time specified by the institution.
In no case, however, shall this period exceed 24 hours.
(3) An order for seclusion or exclusion is
good for only 24 hours. The time the order is received shall be recorded with
the order on the order sheet.
(4)
In mental health/intellectual disability facilities, telephone orders are not
acceptable for continued seclusion or exclusion. The patient/resident shall be
seen by a physician within 24 hours, and the order shall be rewritten and
supported by a progress note. In Youth Development Centers and Youth Forestry
Camps, the resident/patient must be seen by the Superintendent/Assistant
Superintendent who will assess the resident's/patient's needs and seek
professional consultation if indicated.
(5) In the absence of a written or telephone
order, a patient/resident may be placed in seclusion or exclusion as a
protective measure for no more than 1 hour when the action is immediately
necessary.
(6) If a
patient/resident is placed in seclusion or exclusion as an emergency procedure,
the unit program supervisor or appropriate designated program specialist of the
area shall be notified immediately.
(7) In mental health/intellectual disability
facilities, if the nursing supervisor/designated program specialist, after
visiting the patient/resident, deems seclusion or exclusion necessary, the
attending physician or his delegate shall be notified immediately. In Youth
Development Center or Youth Forestry Camp facilities, if the designated program
specialist, after visiting the patient/resident, deems seclusion necessary, the
Superintendent/Assistant Superintendent shall be notified
immediately.
(8) In facilities, the
nursing supervisor or designated program specialist shall document his
observations fully on an appropriate progress report.
(9) The following procedure is to be followed
when a patient/resident is in seclusion:
(i)
Potentially dangerous articles will be removed from the patient/resident. This
includes articles of clothing if there are reasonable grounds to believe such
clothing constitutes a substantial threat to the health or safety of the
patient/resident or others.
(ii)
The patient/resident will be checked at no less than 15-minute intervals by
personnel.
(iii) The physical needs
of the patient/resident will be given prompt response.
(iv) Concise and informative written reports
concerning the status of the patient/resident will be prepared and retained in
the record of the patient/resident in seclusion or exclusion. Daily written
reports concerning patient/residents in seclusion or exclusion shall be
prepared and sent to appropriate designated staff of the facility. These
reports shall include information as follows:
(A) Identifying data concerning name, age,
location in building and record number of patient/resident.
(B) Reason for seclusion or
exclusion.
(C) Period of time in
seclusion or exclusion.
(D) Brief
statement regarding status of patient/resident.
(E) Record of time given for attention to
personal needs.
The provisions of this §13.8 amended under sections 201(2) and (8) and 202 of the Mental Health and Intellectual Disability Act of 1966 (50 P.S. §§ 4201(2) and (8) and 4202).
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