(a) If a facility's policies and procedures permit
the use of mechanical restraint, only commercially available or DSHS-approved
devices specifically designed for the safe and comfortable restraint
of humans shall be used. Any alteration of commercially available
devices or independent development of devices must:
(1) be based on the individual's special physical needs,
if any (e.g., obesity or physical impairment);
(2) take into consideration any potential medical (including
psychiatric) contraindications, including any history of physical
or sexual abuse;
(3) be approved by a committee whose membership and
functions are specified in the bylaws of medical staff members of
the facility; and
(4) be described fully in writing, with a copy of the
description and a photograph forwarded to the DSHS medical director
for behavioral health for review. Such altered or independently developed
device may not be used by the facility unless and until its use is
approved, in writing, by the DSHS medical director for behavioral
health.
(b) A staff member shall inspect a device before and
after each use to ensure that it is clean, in good repair, and is
free from tears or protrusions that may cause injury. Damaged devices
shall not be used to restrain an individual and shall be repaired
or discarded.
(c) Regardless of their commercial availability, the
following types of devices shall not be used to implement a restraint:
(1) those with metal wrist or ankle cuffs;
(2) those with rubber bands, rope, cord, or padlocks
or key locks as fastening devices;
(3) long ties (e.g., leashes);
(4) bed sheets;
(5) gags;
(6) spit hoods, or anything that obstructs an individual's
airway, including a device that places anything in, on, or over the
individual's mouth or nose; and
(7) strait jackets.
(d) Except as otherwise permitted in this subsection,
all forms of restraint, as well as a form of restraint in conjunction
with seclusion, are intended to be used independently of one another.
The physician shall document the clinical justification in the individual's
medical record for the simultaneous use of more than one mechanical
restraint device, a mechanical restraint device and personal restraint,
a mechanical restraint device and seclusion, or personal restraint
and seclusion.
(e) The following are approved mechanical restraint
devices.
(1) Anklets--Padded bands of cloth or leather that
are secured around the individual's ankles or legs using hook-and-loop
(e.g., Velcro®) or buckle fasteners and attached to a stationary
object (e.g., bed or chair frame). The device shall not be secured
so tightly as to interfere with circulation, or so loosely as to permit
chafing of the skin.
(2) Arm splints or elbow immobilizers--Strips of any
material with padding that extend from below to above the elbow and
which are secured around the arm with ties or hook-and-loop (e.g.,
Velcro®) tabs. If appropriate under the circumstances, they shall
be secured so that the individual has full use of the hands. The device
shall not be secured so tightly as to interfere with circulation,
or so loosely as to permit chafing of the skin.
(3) Belts--A cloth or leather band that is fastened
around the waist and secured to a stationary object (e.g., chair frame)
or used for securing the arms to the sides of the body. The device
shall not be secured so tightly as to interfere with breathing or
circulation.
(4) Camisole--A sleeveless cloth jacket that covers
the arms and upper trunk and is secured behind the individual's back.
The device shall not be secured so tightly as to interfere with breathing
or circulation or to cause muscle strain. Staff members shall exercise
caution when using this device, if at all, because it may impair balance
and the individual's ability to break a fall.
(5) Chair restraint--A padded stabilized chair that
supports all body parts and prevents the individual's voluntary egress
from the chair without assistance (e.g., tabletop chair, Geri-chair).
When wristlets or anklets are used to restrict movement from the chair,
the devices must not be secured so tightly as to interfere with breathing
or circulation.
(6) Enclosed bed--A bed with high side rails or another
type of side enclosure and, in some cases, an enclosure (e.g., mesh
or rails) over the bed that prevents the individual's voluntary egress
from the bed without assistance.
(7) Helmet--A plastic, foam rubber, or leather head
covering, such as a sports helmet, that may include an attached face
guard but does not include a spit guard that interferes with breathing
or obstructs the airway. The device shall be the proper size and the
chinstrap shall not be so tight as to interfere with breathing or
circulation.
(8) Mittens--A cloth, plastic, foam rubber, or leather
hand covering such as boxing and other types of sport gloves that
are secured around the wrist or lower arm with elastic, hook-and-loop
(e.g., Velcro®) tabs, ties, paper tape, pull strings, buttons,
or snaps. The device shall not be secured so tightly as to interfere
with circulation.
(9) Restraining net--Mesh fabric that is placed over
an individual's upper and lower trunk with the head, arms, and lower
legs exposed; the net shall be secured over a mattress to a bed frame
and shall never be placed over the individual's head. The restraining
net shall be loose enough to allow some movement. The device shall
not be secured so tightly as to interfere with breathing or circulation.
(10) Restraint bed--A stretcher of steel frame construction
with a fabric cover. The restraint bed shall have an adjustable backrest
and a padded mat which shall be used under the individual's head and
upper body to prevent injury. Approved wristlets, anklets, and belts
shall be used to safely and securely limit the individual's physical
activity.
(11) Restraint board--A padded, rigid board to which
an individual is secured face-up, unless that position is clinically
contraindicated for that individual, in which case a clinically indicated
position will be used and documented. This device shall not be used
to restrain an individual in a behavioral emergency except when necessary
to promptly transport an individual to another location.
(12) Restraint chair or gurney--A chair or gurney manufactured
for the purpose of transporting or restraining an individual.
(13) Ties--A length of cloth or leather used to secure
approved mechanical restraints (e.g., mittens, wristlets, arm splints,
belts, anklets, vests) to a stationary object (e.g., bed or wheelchair
frame) or to another approved mechanical restraint. Ties shall not
be secured so tightly as to interfere with breathing or circulation.
(14) Transport jacket--A heavy canvas sleeveless jacket
that encases the arms and upper trunk, fastens with hook-and-loop
(e.g., Velcro®) tabs and roller buckles, and is held in place
with a strap between the legs. The device shall be used only as a
temporary measure during transport.
(15) Vest--A sleeveless cloth jacket that covers the
upper trunk and is fastened in the back or front with ties or hook-and-loop
tabs (e.g., Velcro®). The vest may be secured to a stationary
object (e.g., bed or chair frame). The vest and ties shall not be
secured so tightly as to interfere with breathing or circulation.
(16) Wristlets--Padded cloth or leather bands that
are secured around the individual's wrists or arms using hook-and-loop
(e.g., Velcro®) or buckle fasteners and attached to a stationary
object (e.g., bed frame, chair frame, or waist belt). The device shall
not be secured so tightly as to interfere with circulation or so loosely
as to permit chafing of the skin.
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