Current through Register Vol. 41, No. 3, September 23, 2024
A. The use of
chemical restraints is prohibited. The use of prone or supine restraints is
prohibited. The use of any restraint or restraint technique that restricts a
resident's breathing, interferes with a resident's ability to communicate, or
applies pressure on a resident's torso is prohibited.
B. Physical restraints shall not be used for
purposes of discipline or convenience. Physical restraints may only be used (i)
as a medical/orthopedic restraint for support, according to a physician's
written order and with the written consent of the resident or his legal
representative or (ii) in an emergency situation after less intrusive
interventions have proven insufficient to prevent imminent threat of death or
serious physical injury to the resident or others.
C. If a restraint is used, it must:
1. Be imposed in accordance with a
physician's written order that specifies the condition, circumstances, and
duration under which the restraint is to be used,; and
2. Not be ordered on a standing, blanket, or
"as needed" (PRN) basis.
D. Whenever physical restraints are used, the
following conditions shall be met:
1. A
restraint shall be used only to the minimum extent necessary to protect the
resident or others;
2. Restraints
shall only be applied by direct care staff who have received training in their
use as specified by subdivision 2 of
22VAC40-73-270;
3. The facility shall closely monitor the
condition of a resident with a restraint, which includes checking on the
resident at least every 30 minutes;
4. The facility shall assist the resident
with a restraint as often as necessary, but no less than 10 minutes every hour,
for his hydration, safety, comfort, range of motion, exercise, elimination, and
other needs;
5. The facility shall
release the resident from the restraint as quickly as possible; and
6. Direct care staff shall keep a record of
restraint usage, outcomes, checks, and any assistance required in subdivision 4
of this subsection and shall note any unusual occurrences or
problems;
E. When
restraints are used in nonemergencies, as defined in
22VAC40-73-10, the following
conditions shall be met:
1. Restraints shall
be used as a last resort and only if the facility, after completing,
implementing, and evaluating the resident's comprehensive assessment and
service plan, determines and documents that less restrictive means have
failed;
2. Physician orders for
medical/orthopedic restraints must be reviewed by the physician at least every
three months and renewed if the circumstances warranting the use of the
restraint continue to exist;
3.
Restraints shall be used in accordance with the resident's service plan, which
documents the need for the restraint and includes a schedule or plan of
rehabilitation training enabling the progressive removal or the progressive use
of less restrictive restraints when appropriate;
4. Before the initial administration of a
restraint, the facility shall explain the use of the restraint and potential
negative outcomes to the resident or his legal representative and the
resident's right to refuse the restraint and shall obtain the written consent
of the resident or his legal representative;
5. Restraints shall be applied so as to cause
no physical injury and the least possible discomfort; and
6. The facility shall notify the resident's
legal representative or designated contact person as soon as practicable, but
no later than 24 hours after the initial administration of a nonemergency
restraint. The facility shall keep the resident and his legal representative or
designated contact person informed about any changes in restraint usage. A
notation shall be made in the resident's record of such notice, including the
date, time, person notified, method of notification, and staff providing
notification.
F. When
restraints are used in emergencies, as defined in
22VAC40-73-10 the following
conditions shall be met:
1. Restraints may
only be used as an emergency intervention of last resort to prevent imminent
threat of death or serious physical injury to the resident or others;
2. An oral or written order shall be obtained
from a physician within one hour of administration of the emergency restraint
and the order shall be documented;
3. In the case of an oral order, a written
order shall be obtained from the physician as soon as possible;
4. The resident shall be within sight and
sound of direct care staff at all times;
5. If the emergency restraint is necessary
for longer than two hours, the resident shall be transferred to a medical or
psychiatric inpatient facility or monitored in the facility by a mental health
crisis team until his condition has stabilized to the point that the attending
physician documents that restraints are not necessary;
6. The facility shall notify the resident's
legal representative or designated contact person as soon as practicable, but
no later than 12 hours after administration of an emergency restraint. A
notation shall be made in the resident's record of such notice, including the
date, time, caller and person notified; and
7. The facility shall review the resident's
individualized service plan within one week of the application of an emergency
restraint and document additional interventions to prevent the future use of
emergency restraints.
Statutory Authority: §§
63.2-217, 63.2-1732, 63.2-1802, 63.2-1805 , and 63.2-1808
of the Code of Virginia.
