Current through Bulletin 2024-06, March 15, 2024
(1) The licensee shall develop and implement
written policies and procedures for the management of conduct between staff and
clients that:
(a) promote the growth,
development and independence of the client;
(b) address the extent that client choice
will be accommodated in daily decision-making, with emphasis on
self-determination and self-management to the extent possible;
(c) specify client conduct that is allowed or
disallowed; and
(d) are made
available to staff, clients, parents of minor children and legal
guardians.
(2) To the
extent possible, clients shall participate in the formulation of the policies
and procedures under Subsection
R432-152-15(1).
(3) Clients may not discipline other clients,
except as part of an organized system of self-government, as outlined in
facility policy.
(4) The licensee
shall develop and implement written policies and procedures that govern the
management of inappropriate client behavior that:
(a) are consistent with the Subsection
R432-152-15(1);
(b) specify facility-approved interventions
to manage inappropriate client behavior;
(c) designate these interventions on a
hierarchy to be implemented, ranging from most positive or least intrusive, to
least positive or most intrusive; and
(d) ensure, before the use of more
restrictive techniques, that less restrictive measures have been implemented
with the results documented in the client's record.
(5) The policies and procedures outlined in
Subsection R432-151-15(4)
shall address the following:
(a) the use of
time-out rooms;
(b) the use of
physical restraints;
(c) the use of
chemical restraints to manage inappropriate behavior;
(d) the application of painful or noxious
stimuli;
(e) the staff members who
may authorize the use of specified interventions; and
(f) a mechanism for monitoring and
controlling the use of such interventions.
(6) The licensee shall ensure interventions
to manage inappropriate client behavior are employed with safeguards and
supervision to ensure that the safety, welfare and civil and human rights of
clients are adequately protected.
(7) A licensee may not utilize as-needed
programs to control inappropriate behavior.
(8) A licensee may place a client in a
time-out room where egress is prevented only if the following conditions are
met:
(a) the placement is part of an approved
systematic timeout program as required by Subsection
R432-152-15(4);
(b) the client is under the direct constant
visual supervision of designated staff;
(c) the door to the room is held shut by
staff or by a mechanism requiring constant physical pressure from a staff
member to keep the mechanism engaged;
(d) placement of a client in a time-out room
does not exceed one hour per incident of maladapted behavior;
(e) clients placed in time-out rooms are
protected from hazardous conditions including sharp corners and objects,
uncovered light fixtures, and unprotected electrical outlets; and
(f) the licensee maintains a log for each
time-out room.
(9) A
licensee may use physical restraints only:
(a)
as an integral part of an individual program plan that is intended to lead to
less restrictive means of managing and eliminating the behavior that the
restraint is applied for;
(b) as an
emergency measure, but only if absolutely necessary to protect the client or
others from injury; or
(c) as a
health-related protection prescribed by a physician, but only if absolutely
necessary during the conduct of a specific medical or surgical procedure or
only if absolutely necessary for client protection during the time that a
medical condition exists.
(10) A licensee may apply emergency
restraints for initial or extended use for no longer than 12 consecutive hours
for the combined initial and extended use time period as long as authorization
is obtained as soon as the client is restrained or stable.
(11) A licensee may not issue orders for
restraint on a standing or as needed basis.
(12)
(a)
The licensee shall ensure staff check clients placed in restraints at least
every 30 minutes and maintain documentation of each check.
(b) Staff shall apply restraints to cause the
least possible discomfort and may not cause physical injury to the
client.
(c) Staff shall provide and
document opportunity for motion and exercise for a period of not less than 10
minutes during each two hour period that a restraint is employed.
(d) Staff may not use barred enclosures more
than three feet in height and barred enclosures may not have tops.
(13)
(a) The licensee may not administer
medications at a dose that interferes with a client's daily living
activities.
(b) The
interdisciplinary team shall approve medications used for the control of
inappropriate behavior and is used only as an integral part of the client's
individual program plan that is directed specifically towards the reduction of
and eventual elimination of the behaviors that the medications are employed
for.
(c) Medications used for
control of inappropriate behavior shall be:
(i) monitored closely, in conjunction with
the physician and the medication review requirement; and
(ii) gradually withdrawn at least annually in
a carefully monitored program conducted in conjunction with the
interdisciplinary team, unless clinical evidence justifies that this is
contraindicated.
