Current through Reg. 49, No. 38; September 20, 2024
(a) Facility documentation. The facility
shall document the assessment, monitoring, and evaluation of an individual in
restraint or seclusion on a facility approved form. Documentation in an
individual's medical record shall include:
(1) the date and time the intervention began
and ended;
(2) the name, title, and
credentials of any staff members present at the initiation of the intervention,
with identification of the staff member's role in the intervention, including
as an observer, or status as an uninvolved witness, as applicable;
(3) the name of the individual restrained or
secluded and the type of restraint or seclusion used;
(4) the time and results of any assessments,
observation, monitoring, and evaluations, including those required under this
subchapter, and attention given to personal needs;
(5) the physician's documentation of the
order authorizing restraint or seclusion in accordance with the requirements of
§ 415.260 of this title (relating to Initiation of Restraint or Seclusion
in a Behavioral Emergency);
(6) any
specific alternatives and less restrictive interventions, including preventive
or de-escalatory interventions that were attempted by any staff member prior to
the initiation of restraint or seclusion, and the individual's response to any
such intervention;
(7) the
individual's response to the use of restraint or seclusion; and
(8) other documentation relating to an
episode of restraint or seclusion otherwise required under this
subchapter.
(b) Report
to CEO. Staff members shall report daily to the facility CEO or designee any
use of a restraint or seclusion.
(1) The CEO
or designee shall take appropriate action to identify and correct unusual or
unwarranted utilization patterns on a systemic basis, and shall address each
specific use of restraint or seclusion that is determined or suspected of being
improper at the time it occurs.
(2)
The CEO or designee shall maintain a central file containing the following
information:
(A) age, gender, and race of the
individual;
(B) deaths or injuries
to the individual or staff members;
(C) length of time the restraint or seclusion
was used;
(D) types and dosage of
emergency medications administered during the restraint or seclusion, if
any;
(E) type of intervention,
including each type of restraint used;
(F) name of staff members who were present
for the initiation of the restraint or seclusion; and
(G) date, day of the week, and time the
intervention was initiated.
(c) Additional reporting in the case of death
or serious injury. By the next business day following an individual's death or
serious injury, facilities shall report the following information to the
appropriate entity designated in subsection (d) of this section.
(1) Each death or serious injury that occurs
while an individual is in restraint or seclusion;
(2) Each death that occurs within 24 hours
after the individual has been removed from restraint or seclusion;
and
(3) Each death known to the
facility that occurs within one week after restraint or seclusion where it is
reasonable to assume that use of restraint or placement in seclusion
contributed directly or indirectly to a individual's death. "Reasonable to
assume" in this context includes, but is not limited to, deaths related to
restrictions of movement for prolonged periods of time, or death related to
chest compression, restriction of breathing, or asphyxiation.
(d) Reporting deaths or serious
injury. Facilities shall report the deaths or serious injuries of individuals
in restraint or seclusion as follows.
(1)
Medicare- or Medicaid-certified facilities shall report a death to the
appropriate office for the Center for Medicare and Medicaid Services in
accordance with the federal death reporting requirements relating to restraint
and seclusion.
(2) Facilities that
are neither Medicare- nor Medicaid-certified shall report a death or serious
injury to DSHS's medical director for behavioral health.
(3) In addition to reporting in accordance
with paragraphs (1) and (2) of this subsection, all facilities licensed under
Chapter 133 of this title (relating to Hospital Licensing) or Chapter 134 of
this title (relating to Private Psychiatric Hospitals and Crisis Stabilization
Units) shall report a death or serious injury to the Patient Quality Care Unit
of DSHS's Division for Regulatory Services.
(4) Facilities shall comply with any
additional reporting requirements relating to restraint or seclusion to which
they are subject, including any applicable reporting requirements under The
Children's Health Act of 2000 and federal regulations promulgated pursuant to
the Act.
(e) Facility
review of data. The facility shall review and analyze, at least quarterly, the
data that is required by subsection (b)(2) of this section to identify and
correct trends and patterns that may contribute to the use of restraint or
seclusion (e.g., disproportionate use of restraint or seclusion with specific
populations or shifts).
(f)
Continuous improvement. The facility shall use the data continuously to improve
and ensure:
(1) a positive environment that
minimizes the use of an involuntary intervention;
(2) the safety of every individual and staff
member;
(3) the use of restraint
and seclusion is implemented in accordance with the requirements of this
subchapter;
(4) that the risks of
injury and other negative effects to individuals and staff members are reduced;
and
(5) that policies and training
curriculum incorporate the requirements of this subchapter.
(g) On or before November 1, 2014,
and quarterly thereafter, any facility that is a Medicare or Medicaid provider
shall submit to DSHS the data required by Centers for Medicare and Medicaid
Services for hospital-based inpatient psychiatric service measures related to
the use of restraint or seclusion.
(h) On or before November 1, 2015, and
quarterly thereafter, a facility to which this subchapter applies shall prepare
and submit to DSHS a report, consistent with the Department of State Health
Services Behavioral Interventions Reporting Guidelines (guidelines) available
at: http://www.dshs.state.tx.us/Licensing-Facilities.shtm,
of the following data from the immediately preceding quarter:
(1) interventions used during a behavioral
emergency, including:
(A) rate of seclusions
(per 1,000 bed days);
(B) rate of
personal restraints (per 1,000 bed days);
(C) rate of mechanical restraints (per 1,000
bed days); and
(D) rate of
emergency medication orders (per 1,000 bed days).
(2) number of serious injuries related to an
intervention used in a behavioral emergency.
(3) number of deaths related to an
intervention used in a behavioral emergency.
(4) de-escalation techniques--description of
all de-escalation techniques commonly used by the facility in connection with
any of the emergency interventions described in paragraph (1) of this
subsection.
