(1) Only staff authorized by the facility's policies
and procedures and who have met the training requirements of §415.257
of this title (relating to Staff Member Training) and demonstrated
competency in the facility's restraint and seclusion training program,
may initiate personal restraint in a behavioral emergency.
(2) Only a physician, registered nurse, or physician
assistant in accordance with a physician's delegated authority, may
initiate mechanical restraint or seclusion.
(b) Physician's order. Only a physician member of the
facility's medical staff may order restraint or seclusion.
(1) The physician's order for restraint or seclusion
(A) designate the specific intervention and procedures
authorized, including any specific measures for ensuring the individual's
safety, health, and well-being;
(B) specify the date, time of day, and maximum length
of time the intervention and procedures may be used, consistent with
the time limitations provided for under §415.261 of this title
(relating to Time Limitation on an Order for Restraint or Seclusion
Initiated in Response to a Behavioral Emergency);
(C) describe the specific behaviors which constituted
the behavioral emergency which resulted in the need for restraint
(D) be signed and dated, including the time of the
order, by the physician or the registered nurse who accepted the prescribing
physician's telephone order.
(2) If restraint or seclusion was ordered by telephone,
the ordering physician shall personally sign and date the telephone
order, including the time of the order, within 48 hours of the time
the order was originally issued.
(3) If the physician who ordered the intervention is
not the treating physician, the physician ordering the intervention
shall consult with the treating physician or physician designee as
soon as possible. The physician who ordered the intervention shall
document the consultation in the individual's medical record.
(c) Face-to-face evaluation. A physician, physician
assistant as provided in paragraph (3) of this subsection, or a registered
nurse who is trained and has demonstrated competence in assessing
medical and psychiatric stability, other than the registered nurse
who initiated the use of restraint or seclusion, shall conduct a face-to-face
evaluation of the individual within one hour following the initiation
of restraint or seclusion to personally verify the need for restraint
(1) The face-to-face evaluation required by this subsection
includes, but is not limited to, an assessment of the:
(A) individual's immediate situation;
(B) individual's reaction to the restraint or seclusion;
(C) individual's medical and behavioral condition;
(D) need to continue or terminate the restraint or
(2) The Waco Center for Youth, a facility accredited
as a residential treatment program, a physician or a registered nurse
who is trained and has demonstrated competence to assess medical and
psychiatric stability other than the registered nurse who initiated
the use of restraint or seclusion shall conduct the face-to-face evaluation
within two hours following the initiation of restraint or seclusion
unless the individual is released prior to the expiration of the original
order. If the individual is released prior to the expiration of the
original order, the physician or registered nurse, shall conduct the
face-to-face evaluation within 24 hours.
(3) A physician may delegate the face-to-face evaluation
to a physician assistant who is:
(A) privileged to practice in the facility or that
portion of the facility to which this subchapter applies; and
(B) under the clinical supervision of a physician appointed
by the facility's medical staff and privileged to practice in the
facility or that portion of the facility.
(4) If a physician assistant to whom the physician
has delegated the face-to-face evaluation or a registered nurse who
has conducted the face-to-face evaluation, in his or her professional
judgment determines that the physician should evaluate the individual
due to circumstances that are outside the physician assistant's or
registered nurse's scope of practice or expertise, the physician assistant
or registered nurse shall contact a physician and request that the
physician perform a face-to-face evaluation of the individual. The
physician assistant or registered nurse shall document the determination
in the individual's medical record.
(5) If the face-to-face evaluation is conducted by
a registered nurse or physician assistant, the registered nurse or
physician assistant shall consult the treating physician or physician
designee who is responsible for the care of the individual as soon
as possible after the completion of the one hour face-to-face evaluation
and document the consultation in the individual's medical record.