Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 967 - CLIENT CARE OF INDIVIDUALS RECEIVING SERVICES AT STATE SUPPORTED LIVING CENTERS
Subchapter B - Use of Restraints in State Supported Living Centers
Section 967.27 - General Provisions
Universal Citation: 26 TX Admin Code § 967.27
Current through Reg. 50, No. 13; March 28, 2025
(a) Expectations.
(1) A facility must implement and
operationalize statewide policy addressing the use of restraint.
(2) At least one person trained as a
restraint monitor must be on duty at all times to respond to the initiation of
restraint procedures in a behavioral crisis, immediately if possible but in no
case in more than 15 minutes. If data suggests a high number of incidents of
restraint, additional restraint monitors may be required.
(3) If an individual is in restraint at the
time of shift change, staff must communicate and coordinate between shifts to
provide continuity of care.
(4) A
licensed nurse must assess, for injuries and other negative health effects, an
individual who has been restrained; determine if the individual's vital signs
are stable; and document the individual's mental status as soon as possible but
within 30 minutes after the initiation of restraint. Staff must continuously
monitor the individual until the licensed nurse arrives.
(5) A mechanical or physical restraint
administered to an individual must:
(A) be
the least restrictive restraint effective to prevent imminent physical harm in
a behavioral crisis, or to safely and effectively implement a medical or dental
procedure, or to prevent or mitigate the documented danger of self-injurious
behavior;
(B) be used for the
shortest period of time necessary to prevent imminent physical injury, to
safely and effectively implement a medical or dental procedure, or to prevent
or mitigate the documented danger of self-injurious behavior;
(C) end immediately once the imminent risk of
physical injury abates;
(D) be
applied with the minimum amount of force or pressure necessary to prevent harm
to the individual and others; and
(E) be used in the safest, least restrictive,
most humane, and most respectful manner possible.
(6) Staff must attempt to provide an
environment that safeguards the individual's personal dignity, privacy, and
well-being while ensuring safety.
(7) Staff must provide continuous one-to-one
supervision to individuals while in restraint. Individuals receiving medical
restraints must receive supervision as ordered by the PCP or dentist in
accordance with facility procedures. The director may approve an alternate
level of supervision based on the IDT's clinical justification and
recommendation.
(8) Staff must
respond appropriately to signs or symptoms of restraint-related injuries or
distress, including an immediate release from restraint and checks by medical
staff.
(9) If an emergency
evacuation or an evacuation drill occurs while an individual is in restraint,
staff must respond as described in the facility's policies and procedures to
ensure the individual's safety.
(10) Staff must allow an individual who has
been released from restraint time to recover and return to regular activities,
including the opportunity to relax and exercise restrained limbs, to drink
fluids, to toilet, to complete a snack or meal, and to receive prescribed
medications.
(11) Staff must take
all necessary steps to avoid causing undue physical discomfort, harm, or pain
to the individual while initiating and implementing restraint.
(12) A facility must obtain legally adequate
consent for a crisis intervention plan, medical restraint plan, or protective
mechanical restraint plan for self-injurious behavior. A plan must be reviewed
by the Behavior Support Committee and the facility director and approved by the
Human Rights Committee before implementation.
(13) An authorization to use or extend
physical restraints in response to a behavioral crisis may be in effect no
longer than 12 consecutive hours.
(b) Allowed uses. Restraints may only be used to protect an individual or others from imminent physical injury resulting from:
(1) a behavioral crisis;
(2) a medical or dental procedure;
or
(3) documented self-injurious
behavior for which intensive, one-to-one supervision and treatment have not
sufficiently reduced the risk of self-injury.
(c) Prohibitions.
(1) A restraint may not be used on an
individual unless the restraint is necessary to prevent imminent physical
injury to the individual or another person.
(2) A restraint may not be used for
punishment, disciplinary purposes, retaliation, retribution, or convenience or
as a substitute for treatment or habilitation.
(3) A restraint may not be used on an
individual as part of a positive behavior support plan.
(4) Prone or supine restraint may not be
used.
(5) A restraint may not be
used if it:
(A) secures the individual to a
stationary object while he or she is in a standing position;
(B) obstructs the individual's airway,
including the placement of anything in, on, or over his or her mouth or
nose;
(C) impairs the individual's
breathing by putting pressure on his or her torso;
(D) interferes with the individual's ability
to communicate;
(E) extends muscle
groups away from each other;
(F)
uses hyperextension of joints;
(G)
uses pressure points or pain; or
(H) is prohibited by the individual's medical
orders or ISP or is medically contraindicated.
(6) A standing order for restraint may not be
used.
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