Current through Reg. 49, No. 38; September 20, 2024
(a) The facilities
to which this subchapter applies shall ensure that staff members are informed
of their roles and responsibilities under this subchapter and are trained and
demonstrate competence accordingly.
(b) The training program shall be consistent
with the requirements of this subchapter and shall:
(1) target the specific needs of each patient
population being served;
(2) be
tailored to the competency levels of the staff members being trained;
(3) emphasize the importance of reducing and
preventing the use of restraint and seclusion;
(4) be evaluated annually, which shall
include evaluation to ensure that the training program, as planned and as
implemented, complies with the requirement of this section;
(5) incorporate evidence-based best
practices;
(6) provide information
about declarations for mental health treatment, including:
(A) the right of individuals to execute
declarations for mental health treatment; and
(B) the duty of staff members and other
health care providers to act in accordance with declarations for mental health
treatment to the fullest extent possible.
(c) Before assuming job duties involving
direct care responsibilities, and at least annually thereafter, staff members
other than physicians must receive training and demonstrate competence in at
least the following knowledge and applied skills that shall be specific and
appropriate to the population(s) the facility serves:
(1) using team work, including team roles and
techniques for facilitating team communication and cohesion;
(2) identifying the causes of aggressive or
threatening behaviors of individuals who need mental health services, including
behavior that may be related to an individual's non-psychiatric medical
condition;
(3) identifying
underlying cognitive functioning and medical, physical, and emotional
conditions;
(4) identifying
medications and their potential effects;
(5) identifying how age, weight, cognitive
functioning, developmental level or functioning, gender, culture, ethnicity,
and elements of trauma-informed care, including history of abuse or trauma and
prior experience with restraint or seclusion, may influence behavioral
emergencies and affect the individual's response to physical contact and
behavioral interventions;
(6)
explaining how the psychological consequences of restraint or seclusion and the
behavior of staff members can affect an individual's behavior, and how the
behavior of individuals can affect a staff member;
(7) applying knowledge and effective use of
communication strategies and a range of early intervention, de-escalation,
mediation, problem-solving, and other non-physical interventions, such as
clinical timeout and quiet time; and
(8) recognizing and appropriately responding
to signs of physical distress in individuals who are restrained or secluded,
including the risks of asphyxiation, aspiration, and trauma.
(d) Before any staff member may
initiate any restraint or seclusion the staff member shall receive training and
demonstrate competence in:
(1) safe and
appropriate initiation and use of seclusion as a last resort in a behavioral
emergency;
(2) safe and appropriate
initiation and application, and use of personal restraint as a last resort in a
behavioral emergency;
(3) safe and
appropriate initiation and application, and use of mechanical restraint devices
as a last resort in a behavioral emergency or as a protective or supportive
device, and knowledge of the mechanical restraint devices permitted under
§
415.256
of this title (relating to Mechanical Restraint Devices) and approved by the
facility; and
(4) management of
emergency medical conditions in accordance with the facility's policies and
procedures and other applicable requirements for:
(A) obtaining emergency medical assistance;
and
(B) obtaining training in and
using techniques for cardiopulmonary respiration and removal of airway
obstructions.
(e) Before assuming job duties, and at least
annually thereafter, a registered nurse or a physician assistant who is
authorized to:
(1) perform assessments of
individuals who are in restraint or seclusion shall receive training, which
shall include a demonstration of competence in:
(A) monitoring cardiac and respiratory status
and interpreting their relevance to the physical safety of the individual in
restraint or seclusion;
(B)
recognizing and responding to nutritional and hydration needs;
(C) checking circulation in, and range of
motion of, the extremities;
(D)
providing for hygiene and elimination;
(E) identifying and responding to physical
and psychological status and comfort, including signs of distress;
(F) assisting individuals in de-escalating,
including through identification and removal of stimuli, that meet the criteria
for a behavioral emergency if known;
(G) recognizing when continuation of
restraint or seclusion is no longer justified by a behavioral emergency;
and
(H) recognizing when to contact
emergency medical services to evaluate and/or treat an individual for an
emergency medical condition.
(2) conduct evaluations of individuals,
including face-to-face evaluations pursuant to § 415.260(c) of this title
(relating to Initiation of Restraint or Seclusion in a Behavioral Emergency) of
individuals who are in restraint or seclusion, shall receive training, which
shall include a demonstration of competence in:
(A) identifying restraints that are permitted
by the facility, by this subchapter, and by other applicable law;
(B) identifying stimuli that trigger
behaviors;
(C) identifying medical
contraindications to restraint and seclusion;
(D) recognizing psychological factors to be
considered when using restraint and seclusion, such as sexual abuse, physical
abuse, neglect, and trauma.
(f) Before assuming job duties, and at least
annually thereafter, staff members who are authorized to monitor, under the
supervision of a registered nurse, individuals during restraint or seclusion
shall receive training, which shall include a demonstration of competence in:
(1) monitoring respiratory status;
(2) recognizing nutritional and hydration
needs;
(3) checking circulation in,
and range of motion of, the extremities;
(4) providing for hygiene and
elimination;
(5) addressing
physical and psychological status and comfort, including signs of
distress;
(6) assisting individuals
in de-escalating, including through identification and removal of stimuli, if
known.
(7) recognizing when
continuation of restraint or seclusion is no longer justified by a behavioral
emergency; and
(8) recognizing when
to contact a registered nurse.
(g) For physicians who may order restraint or
seclusion, the facility's credentialing and privileging processes must require
that such physicians:
(1) demonstrate
competency in ordering restraint or seclusion; and
(2) receive training and refresher training
in:
(A) the use of alternatives to restraint
or seclusion; and
(B) how to reduce
the physical and emotional harm caused by restraint or seclusion.
(h) When a staff
member's duties change, the facility shall reassess the staff member's training
and competence and require and ensure the staff member's retraining, as
required under this subchapter, based upon the facility's reassessment and the
staff member's new duties.
(i) The
facility shall maintain documentation of training for each staff member.
Documentation shall include the date that training was completed, the name of
the instructor, a list of successfully demonstrated competencies, the date
competencies were assessed, and the name of the person who assessed
competence.
