(a) The following definitions apply to this section:
(1) Critical incident means:
(A) a medication error;
(B) a serious physical injury;
(C) a behavior intervention plan that authorizes restraint;
(D) an emergency personal restraint;
(E) an emergency mechanical restraint; or
(F) an emergency psychoactive medication restraint.
(2) Emergency mechanical restraint means the use of
a mechanical restraint on an individual not in accordance with a written
behavior intervention plan approved by the individual's IDT.
(3) Emergency personal restraint means the use of
a personal restraint on an individual not in accordance with a written
behavior intervention plan approved by the individual's IDT.
(4) Emergency psychoactive restraint means the use
of a psychoactive medication restraint on an individual not in accordance
a written behavior intervention plan approved by the individual's
IDT.
(5) A behavior intervention plan that authorizes restraint
means a behavior intervention plan approved by the individual's IDT
that authorizes personal restraint, mechanical restraint, or psychoactive
medication restraint.
(6) Mechanical restraint means the use of a device
that restricts the free movement of part or all of an individual's
body, including the use of an anklet, a wristlet, a camisole, a helmet
with fasteners, a mitt with fasteners, a vest, a waist strap, a head
strap, or a restraining sheet, but does not include the use of a device
that provides support for functional body position or proper balance,
such as a wheelchair belt, or that is used for medical treatment,
such as a helmet to prevent injury during a seizure.
(7) Medication error means a difference between what
is prescribed to an individual who self-administers medication under
the supervision of the program provider or who has medication administered
by the program provider and what the individual actually takes, but
does not include an individual's refusal to take medication. The following
are examples of medication errors:
(A) an individual takes medication that is not prescribed
for the individual, including medication that has been discontinued
for the individual or that was improperly labeled;
(B) an individual takes an amount of medication different
from the amount prescribed or the route prescribed for the individual;
(C) an individual does not take a prescribed dose of
medication within one hour before or one hour after the prescribed
time; and
(D) an individual does not take a medication as prescribed
in relation to a meal.
(8) Personal restraint means the application of pressure,
except physical guidance or prompting of brief duration that restricts
the free movement of part or all of an individual's body.
(9) Psychoactive medication restraint means the use
of a chemical, including a pharmaceutical, to control an individual's
activity, if the chemical is not a standard treatment for the individual's
medical or psychiatric condition.
(10) Serious physical injury is an injury determined
serious by a physician, physician assistant, advance practice nurse,
or a registered nurse, regardless of the cause or setting in which
the injury occurred. A serious physical injury may include a fracture,
a dislocation of any joint, an internal injury, a contusion larger
than two and half inches in diameter, a concussion, a second or third
degree burn, a laceration requiring sutures.
(b) A program provider must report to DADS the following
information related to the critical incidents that occur in a calendar
month:
(1) the number of medication errors;
(2) the number of individuals who have behavior intervention
plans that authorize restraint;
(3) the number of times emergency personal restraint
was used;
(4) the number of times emergency mechanical restraint
was used;
(5) the number of times emergency psychoactive medication
restraint was used;
(6) the number of times a serious physical injury was
sustained;
(7) the number of times a serious physical injury was
sustained due to personal restraint;
(8) the number of times a serious physical injury
was sustained due to mechanical restraint;
(9) the number of times a serious physical injury was
sustained due to psychoactive medication restraint;
(10) the number of individuals who required restraint;
(11) the number of individuals who required emergency
personal restraint;
(12) the number of individuals who required emergency
mechanical restraint; and
(13) the number of individuals who required emergency
psychoactive medication restraint.
(c) The program provider must make a report described
in subsection (b) of this section within 30 days after the last day
of the month in which the critical incidents occur. A program provider
must make a separate report for each facility.
(d) A program provider must evaluate its use of restraint
at least annually. The evaluation must, at a minimum, compare aggregate
data provided by DADS at www.dads.state.tx.us for similarly sized
facilities.
(e) Based on its evaluation, the program provider must
develop and implement a plan to reduce the use of restraints.
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Source Note: The provisions of this §261.229 adopted to be effective November 30, 2011, 36 TexReg 8048; transferred effective October 1, 2020, as published in the Texas Register August 28, 2020, 45 TexReg 6127 |