| (a) Within 30 calendar days of receiving services from
a program provider and annually thereafter, a program provider must:
(1) with the involvement of a physician, identify:
(A) the individual's known physical or medical conditions
that might constitute a risk to the individual during the use of restraint;
(B) the individual's ability to communicate; and
(C) other factors that must be taken into account if
the use of restraint is considered, including the individual's:
(i) cognitive functioning level;
(ii) height;
(iii) weight;
(iv) emotional condition that could contraindicate
the use of restraint, including whether the individual has a history
of having been physically or sexually abused; and
(v) age;
(2) document the conditions and factors identified
in accordance with paragraph (1) of this subsection, and, as applicable,
limitations on specific restraint techniques or mechanical restraint
devices in the individual's record; and
(3) review and update with a physician, registered
nurse (RN), or licensed vocational nurse (LVN), at least annually
or when a condition or factor documented in accordance with paragraph
(2) of this subsection changes significantly, information in the individual's
record related to the identified condition, factor, or limitation.
(b) A program provider may use a restraint:
(1) in a behavioral emergency;
(2) as part of a behavior support plan that addresses
inappropriate behavior exhibited voluntarily by an individual;
(3) during or as a follow-up to a medical or dental
procedure or treatment of an injury if the restraint is ordered by
the physician or dentist as necessary to protect the individual or
others or promote the healing of wounds;
(4) to protect the individual from involuntary self-injury;
and
(5) if used as a protective device in accordance with §565.37
of this subchapter (relating to Protective Devices).
(c) A program provider must not use restraint:
(1) in a manner that:
(A) restricts circulation;
(B) obstructs the individual's airway, including the
placement of anything in, on, or over the individual's mouth or nose;
(C) impairs the individual's breathing by putting pressure
on the individual's torso;
(D) interferes with the individual's ability to communicate;
(E) places the individual in a prone or supine position;
(F) extends muscle groups away from each other;
(G) uses hyperextension of joints;
(H) uses pressure points or pain; or
(I) secures the individual to a stationary object while
the individual is in a standing position;
(2) for disciplinary purposes, that is, as retaliation
or retribution;
(3) for the convenience of a staff member or service
provider or other individuals; or
(4) as a substitute for effective treatment or habilitation.
(d) If a program provider restrains an individual as
provided in subsection (b) of this section, the program provider must:
(1) take into account the conditions, factors, and
limitations on specific restraint techniques or mechanical restraint
devices documented in accordance with subsection (a)(2) and (3) of
this section;
(2) use the minimal amount of force or pressure that
is reasonable and necessary to ensure the safety of the individual
and others; and
(3) safeguard the individual's dignity, privacy, and
well-being.
(e) In a circumstance described in subsection (b)(1)
or (2) of this section, a program provider may use only a restraint
hold in which the individual's limbs are held close to the body to
limit or prevent movement and that does not violate the provisions
of subsection(c)(1) of this section.
(f) A program provider must release an individual from
restraint:
(1) as soon as the individual no longer poses a risk
of imminent physical harm to the individual or others;
(2) if the individual in restraint experiences a medical
emergency, as soon as possible as indicated by the medical emergency;
or
(3) as soon as an individual in a restraint hold described
in subsection (e) of this section who moves toward the floor reaches
the floor.
(g) After restraining an individual in a behavioral
emergency, a program provider must:
(1) as soon as possible but no later than one hour
after the use of restraint, notify an RN or LVN of the restraint;
(2) ensure that medical services are obtained for the
individual as necessary;
(3) as soon as possible but no later than 24 hours
after the use of restraint, notify one of the following persons, if
there is such a person, that the individual has been restrained:
(A) the individual's legally authorized representative;
or
(B) a person actively involved with the individual,
unless the release of this information would violate other law; and
(4) notify the individual's service coordinator by
the end of the first business day after the use of restraint.
(h) If, under the Health Insurance Portability and
Accountability Act, the program provider is a "covered entity," as
defined in 45 Code of Federal Regulations (CFR) §160.103, any
notification provided under subsection (g)(3)(B) of this section must
be to a person to whom the program provider is allowed to release
information under 45 CFR §164.510.
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