| (a) Purpose. This rule establishes the criteria, procedures,
and limitations for use of four-point restraints when used for medical
or mental health purposes.
(b) Applicability.
(1) This rule applies to all residential facilities
operated by the Texas Juvenile Justice Department (TJJD) that are
authorized to administer four-point restraints.
(2) This rule applies only to four-point mechanical
restraints. For all other types of restraint used for medical or mental
health purposes, provisions of §380.9723 of this title apply.
(c) Additional References. For criteria on administering
a psychotropic drug in a psychiatric emergency when a youth will not
give consent for the administration, see §380.9192 of this title.
(d) Definitions. For definitions of terms used in this
section, see §380.9175 of this title.
(e) General Provisions.
(1) Four-point restraints may only be used for medical
or mental health purposes as described by this rule. Four-point restraints
may not be used for any other purpose.
(2) Restraint equipment used for medical or mental
health purposes must be used only in a manner consistent with its
intended design and purpose.
(3) Only restraint equipment approved by the executive
director or designee may be used in TJJD facilities.
(4) TJJD staff who will participate in the application
of four-point restraints or monitoring, managing, or approving the
restraint must receive special training and may not participate in
its implementation until the training has been received. The training
will include proper use and application of restraint devices and applicable
TJJD policies and guidelines regarding the implementation, documentation,
and possible continuation of the restraint.
(5) If facility resources are not sufficient to support
the procedural requirements specified in this rule, four-point restraints
must not be used.
(6) A medical provider must be consulted prior to placing
a youth in a four-point restraint device if the youth is pregnant
or has a seizure disorder or any other medical condition that contraindicates
such restraint.
(7) The facility administrator or designee must ensure
that the parent/guardian of a youth placed in a four-point restraint
is notified within 24 hours after the restraint is initiated.
(f) Four-Point Restraints for Medical Purposes.
(1) Authorized Facilities.
Four-point medical restraints are authorized only at high restriction
facilities that:
(A) operate an on-site infirmary; and
(B) have been authorized by the executive director
or designee to administer four-point restraints.
(2) Criteria for Use. Medical restraints may be used
only to administer medical treatment to a resistant youth when failure
to administer the treatment could have serious health implications
as determined by a physician or mid-level practitioner (such as a
nurse practitioner or physician assistant).
(3) Authorization for Use.
(A) Only a medical provider may order a medical restraint.
The order must be based upon a determination that:
(i) all appropriate, less restrictive interventions
have proved unsuccessful in controlling the youth's behavior to a
degree that would allow the medical treatment to be administered;
and
(ii) transfer to a local emergency room or other appropriate
facility is not immediately feasible.
(B) An order for medical restraint must specify the
type of restraint to be used, duration of the restraint, any special
instructions, and justification for the restraint.
(C) Prior to the expiration of the first hour, a registered
nurse must contact the medical provider to develop a treatment plan,
if the restraint is still needed. The treatment plan must include
transfer to a local emergency room or other appropriate facility if
the need for restraint exceeds one hour.
(4) Procedural Requirements.
(A) A medical provider or nurse must be present during
the application of restraints.
(B) Youth are provided:
(i) 15-minute checks by healthcare staff to assess
the youth's condition, including circulation, position, and open airway.
Such checks must be documented in the youth's medical record;
(ii) range-of-motion exercises performed by a nurse
at least every 30 minutes for a period of at least five minutes;
(iii) regularly scheduled meals and drinks;
(iv) continuous visual supervision by staff; and
(v) opportunities for elimination of bodily waste as
needed.
(C) A medical restraint must be terminated upon a determination
by the medical provider that the youth's behavior no longer justifies
application of medical restraints or expiration of the provider's
order, whichever occurs first.
(g) Four-Point Restraints for Mental Health Purposes.
(1) Authorized Facilities. Four-point mental health
restraints are authorized only at facilities designated by the executive
director or designee.
(2) Criteria for Use.
(A) Four-point restraints for mental health purposes
are authorized for use only when the restraint is necessary to prevent
serious self-injury and all appropriate, less restrictive interventions
have proven unsuccessful in controlling the youth's self-injurious
behavior, as determined by a designated mental health professional
or a psychiatric provider.
(B) The restraint must be terminated as soon as the
youth's behavior indicates the threat of imminent self-injury is absent,
as determined by a designated mental health professional or psychiatric
provider.
(3) Authorization to Initiate and Continue Restraint.
(A) Only a designated mental health professional or
a psychiatric provider may authorize the initiation of a mental health
restraint.
(B) At least one staff member trained specifically
in mental health restraint techniques must be involved in the application
of the restraint. If at least one trained staff member is not available,
the restraint may not be used.
(C) Before the end of the first hour of restraint,
the designated mental health professional or psychiatric provider
must determine whether to continue the restraint.
(D) Before the end of the second hour of restraint:
(i) a mental health professional must conduct a face-to-face
assessment of the youth; and
(ii) the designated mental health professional or psychiatric
provider must determine whether to continue the restraint.
(E) Before the end of the fourth hour of restraint
and at least once every four hours thereafter:
(i) a mental health professional must conduct a face-to-face
assessment of the youth;
(ii) the designated mental health professional and
psychiatric provider must be notified of the youth's status; and
(iii) the designated mental health professional or
psychiatric provider must determine whether to continue the restraint.
(F) No order or approval for mental health restraint
may be in force for longer than eight hours without consultation with
a psychiatric provider.
(G) No order or approval for mental health restraint
may be in force for longer than 12 hours without:
(i) direct observation of the youth by the designated
mental health professional;
(ii) a written order to extend the restraint from the
psychiatric provider; and
(iii) written instructions from the designated mental
health professional regarding continued assessments and monitoring.
(4) Procedural Requirements.
(A) A specially trained, on-site staff member must
manage the entire restraint incident. Duties of this staff member
include:
(i) ensuring policy and procedure are followed;
(ii) notifying the designated mental health professional
or psychiatric provider of any significant changes in the youth's
behavior;
(iii) ensuring required documentation and notifications
are completed; and
(iv) assigning one or more staff members to:
(I) provide continuous supervision of the youth for
the duration of the incident;
(II) document the youth's behavior and emotional state;
and
(III) facilitate communication between all staff members
involved in the restraint.
(B) Staff must ensure the youth's personal dignity
by providing a protected environment and as much privacy as possible.
(C) Youth must be provided:
Cont'd... |
