(1) A facility must implement and operationalize statewide
policy addressing the use of restraint.
(2) At least one person trained as a restraint monitor
must be on duty at all times to respond to the initiation of restraint
procedures in a behavioral crisis, immediately if possible but in
no case in more than 15 minutes. If data suggests a high number of
incidents of restraint, additional restraint monitors may be required.
(3) If an individual is in restraint at the time of
shift change, staff must communicate and coordinate between shifts
to provide continuity of care.
(4) A licensed nurse must assess, for injuries and
other negative health effects, an individual who has been restrained;
determine if the individual's vital signs are stable; and document
the individual's mental status as soon as possible but within 30 minutes
after the initiation of restraint. Staff must continuously monitor
the individual until the licensed nurse arrives.
(5) A mechanical or physical restraint administered
to an individual must:
(A) be the least restrictive restraint effective to
prevent imminent physical harm in a behavioral crisis, or to safely
and effectively implement a medical or dental procedure, or to prevent
or mitigate the documented danger of self-injurious behavior;
(B) be used for the shortest period of time necessary
to prevent imminent physical injury, to safely and effectively implement
a medical or dental procedure, or to prevent or mitigate the documented
danger of self-injurious behavior;
(C) end immediately once the imminent risk of physical
(D) be applied with the minimum amount of force or
pressure necessary to prevent harm to the individual and others; and
(E) be used in the safest, least restrictive, most
humane, and most respectful manner possible.
(6) Staff must attempt to provide an environment that
safeguards the individual's personal dignity, privacy, and well-being
while ensuring safety.
(7) Staff must provide continuous one-to-one supervision
to individuals while in restraint. Individuals receiving medical restraints
must receive supervision as ordered by the PCP or dentist in accordance
with facility procedures. The director may approve an alternate level
of supervision based on the IDT's clinical justification and recommendation.
(8) Staff must respond appropriately to signs or symptoms
of restraint-related injuries or distress, including an immediate
release from restraint and checks by medical staff.
(9) If an emergency evacuation or an evacuation drill
occurs while an individual is in restraint, staff must respond as
described in the facility's policies and procedures to ensure the
(10) Staff must allow an individual who has been released
from restraint time to recover and return to regular activities, including
the opportunity to relax and exercise restrained limbs, to drink fluids,
to toilet, to complete a snack or meal, and to receive prescribed
(11) Staff must take all necessary steps to avoid causing
undue physical discomfort, harm, or pain to the individual while initiating
and implementing restraint.
(12) A facility must obtain legally adequate consent
for a crisis intervention plan, medical restraint plan, or protective
mechanical restraint plan for self-injurious behavior. A plan must
be reviewed by the Behavior Support Committee and the facility director
and approved by the Human Rights Committee before implementation.
(13) An authorization to use or extend physical restraints
in response to a behavioral crisis may be in effect no longer than
12 consecutive hours.
(b) Allowed uses. Restraints may only be used to protect
an individual or others from imminent physical injury resulting from:
(1) a behavioral crisis;
(2) a medical or dental procedure; or
(3) documented self-injurious behavior for which intensive,
one-to-one supervision and treatment have not sufficiently reduced
the risk of self-injury.
(1) A restraint may not be used on an individual unless
the restraint is necessary to prevent imminent physical injury to
the individual or another person.
(2) A restraint may not be used for punishment, disciplinary
purposes, retaliation, retribution, or convenience or as a substitute
for treatment or habilitation.
(3) A restraint may not be used on an individual as
part of a positive behavior support plan.
(4) Prone or supine restraint may not be used.
(5) A restraint may not be used if it:
(A) secures the individual to a stationary object while
he or she is in a standing position;
(B) obstructs the individual's airway, including the
placement of anything in, on, or over his or her mouth or nose;
(C) impairs the individual's breathing by putting pressure
on his or her torso;
(D) interferes with the individual's ability to communicate;
(E) extends muscle groups away from each other;
(F) uses hyperextension of joints;
(G) uses pressure points or pain; or
(H) is prohibited by the individual's medical orders
or ISP or is medically contraindicated.
(6) A standing order for restraint may not be used.