|(a) Non-ambulatory mechanical restraints shall be used
only in response to a resident's overt self-injurious behavior and
only when other less restrictive interventions or other forms of physical
restraint have been deemed to be inappropriate or ineffective.
(b) The initial use of non-ambulatory mechanical restraints
shall receive incident-specific authorization from the facility administrator
or designee. Standing orders authorizing non-ambulatory mechanical
restraints are prohibited.
(c) Non-ambulatory mechanical restraints shall be conducted
in an area or room that is not visible to other residents but in a
location that is readily accessible to health care professionals or
specially trained staff with supervisory responsibilities specific
to the oversight of the non-ambulatory mechanical restraints.
(d) A room or cell with fixed or static non-ambulatory
mechanical restraint fixtures or mechanisms (e.g., anchoring points
or devices) shall be used to house a resident who is not being restrained
in a non-ambulatory mechanical restraint only if the resident is being
provided constant supervision.
(e) Non-ambulatory mechanical restraints shall be restricted
to professionally manufactured, standards-compliant restraint beds,
restraint chairs, and soft restraint devices.
(f) A written recommendation from a health care professional
or a mental health provider is required for a non-ambulatory mechanical
restraint to continue longer than one hour.
(g) Non-ambulatory mechanical restraints lasting two
hours in duration shall be considered a behavioral health crisis and
shall result in an immediate referral to a mental health provider
or a mental health facility for assessment and possible treatment.
(h) Under no circumstances shall a non-ambulatory mechanical
restraint exceed three hours in duration within a 24-hour period.
The collective time a resident spends in multiple non-ambulatory mechanical
restraints occurring within a 24-hour period shall not exceed three
(i) Residents in a non-ambulatory mechanical restraint
shall be provided:
(1) constant visual supervision by a juvenile supervision
officer or juvenile probation officer;
(2) an opportunity for expanded physical motion for
not less than five minutes at every 30-minute interval;
(3) an opportunity to drink water every hour;
(4) regularly prescribed medications, unless otherwise
ordered by a physician; and
(5) an opportunity to eliminate bodily waste at least
(j) The constant visual supervision required in subsection
(i)(1) of this section may be from behind an architectural barrier,
such as a window, as long as the constant visual supervision is not
interrupted or impeded.
(k) Requirements in subsection (i) of this section
shall be fully documented and retained in the facility record or resident
file. The juvenile supervision officer or juvenile probation officer
shall document any instance in which the resident's aggressive behavior
prevents staff from providing any of the items listed in subsection
(i) of this section.
(l) The following documentation shall be retained in
the facility record or resident file:
(1) an assessment of the resident's circulation, positioning,
and breathing conducted at least every ten minutes by a specially
trained juvenile supervision officer or a health care professional;
(2) documented checks, performed by a health care professional
or specially trained staff, of the physical condition of the resident
and the placement of the mechanical restraint devices within the first
30 minutes of the restraint and every hour thereafter.
(m) The officer responsible for providing the constant
visual supervision of a resident in a non-ambulatory mechanical restraint
shall have physical possession of the key or other mechanism for releasing
the resident from the restraint.
(n) Any juvenile probation officer or juvenile supervision
officer authorized to place a resident in a non-ambulatory mechanical
restraint shall be trained in topics that include:
(1) monitoring the vital signs and critical circulation
points of a resident placed in the non-ambulatory mechanical restraint;
(2) emergency procedures for the removal of a resident
from the non-ambulatory mechanical restraint.
|Source Note: The provisions of this §343.812 adopted to be effective January 1, 2010, 34 TexReg 7095; amended to be effective September 1, 2013, 38 TexReg 4387; amended to be effective January 1, 2015, 39 TexReg 9243