Current through Reg. 50, No. 13; March 28, 2025
(a) Prohibition.
Except as provided by this subchapter, the use of restraint or seclusion is
prohibited.
(b) Use of personal or
mechanical restraint or seclusion. The use of personal or mechanical restraint
or seclusion is permissible on the facility's premises, and personal or
mechanical restraint is permissible for transportation of an individual only if
implemented:
(1) in accordance with this
subchapter;
(2) when less
restrictive interventions (such as those listed in the safety plan if there is
one) are determined ineffective to protect other individuals, the individual,
staff members, or others from harm;
(3) in accordance with, and using only those
safe and appropriate techniques as determined by the facility's written
policies or procedures and training program as specified in subsection (e) of
this section;
(4) by staff members
who have been trained in accordance with the applicable requirements specified
in § 415.257 of this title (relating to Staff Member Training);
(5) in connection with the applicable
evaluation and monitoring requirements specified in § 415.266 of this
title (relating to Observation, Monitoring, and Care of the Individual in
Restraint or Seclusion Initiated in Response to a Behavioral
Emergency);
(6) in accordance with
the applicable initiation and physician order requirements specified in §
415.260 of this title (relating to Initiation of Restraint or Seclusion in a
Behavioral Emergency);
(7) in
accordance with any alternative strategies and special considerations
documented in the treatment plan pursuant to § 415.259(c) of this title
(relating to Special Considerations, Responsibilities, and Alternative
Strategies);
(8) when the type or
technique of restraint or seclusion used is the least restrictive intervention
that will be effective to protect the other individuals, the individual, staff
members, or others from harm; and
(9) is discontinued at the earliest possible
time, regardless of the length of time identified in a physician's
order.
(c) Facility
requirements. A facility's use of restraint and seclusion is prohibited unless:
(1) the facility adopts, implements, and
enforces written policies and procedures, in accordance with this subchapter,
governing the use of restraint and seclusion;
(2) the facility adopts, implements, and
enforces a staff member training program that meets the requirements of §
415.257 of this title; and
(3)
staff members of the facility are trained and have demonstrated competence in
the use of restraint and seclusion in accordance with the facility's written
policies and procedures and training program before assuming direct care duties
and before performing restraint and seclusion on the
individual.
(d) Policy
notification. Upon admission of an individual, or as soon as possible
thereafter, the facility shall notify each individual and each individual's
legally authorized representative (LAR), if any, of the facility's policies
related to the use of restraint and seclusion. The policy notification may be a
summary of the facility's policy. If an LAR cannot be notified, the facility
shall document the reason in the individual's medical record.
(e) This subchapter represents minimum
standards. The facility may, through its written policies and procedures, adopt
more stringent standards that are consistent with this subchapter and do not
conflict with:
(2) state or federal laws; and
(3) applicable accreditation
standards.
