(a) All off-premises transport. A registered nurse
or physician assistant, as appropriate to the individual's clinical
condition and the requirements of this subchapter, shall accompany
the staff member(s) transporting an individual off premises when it
has been clinically determined that during the time away from the
facility the individual may require:
(1) medical attention;
(2) administration of medication; or
(3) restraint.
(b) Excursion off facility premises. A staff member
may not restrain an individual being transported off facility premises
unless the individual meets the criteria for a behavioral emergency,
a physician orders the restraint, and transport is medically necessary
with documented clinical justification.
(1) If restraint is required while an individual is
on an excursion off facility premises, the staff member initiating
the restraint shall contact a registered nurse to assist in obtaining
a physician's order for the restraint as soon as feasible within the
applicable timeframes prescribed in this subchapter.
(2) The staff members on the excursion shall implement,
monitor, document, and report, in accordance with the requirements
of this subchapter, any episode of restraint that occurs off premises.
(c) Restraint initiated prior to transportation. A
staff member may not restrain an individual being transported prior
to departure unless the situation meets the criteria for a behavioral
emergency or the individual has been determined and documented manifestly
dangerous in accordance with Chapter 415, Subchapter G of this title
(relating to Determination of Manifest Dangerousness) within one month
prior to transportation, a physician orders the restraint, and transport
is medically necessary with documented clinical justification.
(1) If a behavioral emergency exists and a physician
orders restraint prior to departure, at least one of the staff members
accompanying the individual to the destination facility shall be a
registered nurse.
(2) A female staff member shall accompany a female
individual.
(3) If the duration of transport exceeds the maximum
allowable duration of restraint on the original order, and a behavioral
emergency continues to exist, or the person has been determined manifestly
dangerous within one month prior to transportation, the registered
nurse may either obtain a physician's telephone order to renew the
restraint or obtain a new order for restraint, and renewal, as soon
as feasible but within the applicable timeframes prescribed in this
subchapter.
(4) Staff members accompanying the individual from
the originating facility shall implement, monitor, document, and report,
in accordance with the requirements of this subchapter, a restraint
that is ordered and implemented prior to transportation. If transportation
is for the purposes of transfer to another facility, staff members
at the originating facility must fax the required documentation to
the destination facility on the day of transport. Staff members at
the destination facility are responsible for filing the documentation
in the individual's medical record at the destination facility.
(d) Restraint initiated during transportation. If restraint
is required following departure, a registered nurse shall obtain a
physician's order from the originating facility for any restraint
as soon as feasible within the applicable timeframes prescribed in
this subchapter. If a registered nurse is not present during transportation,
the staff member initiating any restraint shall contact a registered
nurse to obtain a physician's order for the restraint as soon as possible
within the applicable timeframes prescribed in this subchapter.
(1) If an individual is restrained during transportation,
the staff member accompanying the individual shall implement, monitor,
document, and report the episode of restraint in accordance with the
requirements of this subchapter, and shall ensure that all documentation
required under this subchapter relating to the restraint, including
the physician's order, is transmitted to the destination facility
within 24 hours following the time the individual is delivered to
the destination facility.
(2) Staff members at the originating facility shall
document and report restraint that is ordered and implemented during
transportation. Staff members at the destination facility shall maintain
documentation of the restraint at the destination facility.
(e) Comfort during transportation. The staff members
shall provide an individual in restraint during transport the care
required under §415.266(c) of this title (relating to Observation,
Monitoring, and Care of the Individual in Restraint or Seclusion Initiated
in Response to a Behavioral Emergency).
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