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RULE §42.409Restraints

(a) A restraint is a restrictive intervention that a program provider may use in accordance with this section.

(b) A program provider providing licensed assisted living must comply with §92.41(p) of this title (relating to Standards for Type A and Type B Assisted Living Facilities).

(c) A program provider must ensure that a six-bed ICF/IID providing respite complies with §90.42(e)(4) of this title (relating to Standards for Facilities Serving Individuals with an Intellectual Disability or Related Conditions).

(d) A program provider providing licensed home health assisted living:

  (1) must not use restraints:

    (A) for disciplinary purposes, retaliation, coercion, or retribution;

    (B) for the convenience of a service provider or other persons; or

    (C) as a substitute for an effective, less restrictive method;

  (2) may use a restraint only:

    (A) if the use is authorized in writing by a physician and specifies:

      (i) the circumstances under which the restraint may be used; and

      (ii) the duration for which the restraint may be used; or

    (B) if the use is necessary in a behavioral emergency to protect the individual or others from injury;

  (3) except in a behavioral emergency, must ensure:

    (A) that a service provider who uses a restraint has been trained in the use of the restraint:

      (i) before using the restraint;

      (ii) annually; and

      (iii) when the individual's needs change; and

    (B) that the training is documented in the service provider's record;

  (4) must not use a restraint under any circumstance if it:

    (A) obstructs the individual's airway, including a procedure that places anything in, on, or over the individual's mouth or nose;

    (B) impairs the individual's breathing by putting pressure on the individual's torso;

    (C) interferes with the individual's ability to communicate; or

    (D) places the individual in a prone or supine position;

  (5) must ensure that if a physical restraint is used in a behavioral emergency:

    (A) it must be a restraint 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 paragraph (4) of this subsection;

    (B) that as soon as possible but no later than one hour after the use of the restraint, the service provider notifies an RN of the restraint;

    (C) that after the RN is notified of the use of the restraint, the service provider documents the RN's instructions to the service provider;

    (D) that medical services are obtained for the individual as necessary;

    (E) the program provider:

      (i) with the individual's consent, makes an appointment with a physician no later than the end of the first working day after the use of restraint and document in the individual's record that the appointment was made; or

      (ii) if the individual refuses to see a physician, documents the refusal in the individual's record; and

    (F) that as soon as possible but no later than 24 hours after the use of restraint, the program provider notifies one of the following persons, if there is such a person, that the individual has been restrained:

      (i) the individual's LAR; or

      (ii) a person actively involved in the individual's care, unless the release of this information would violate other law;

  (6) that uses a restraint must document in an individual's case record:

    (A) the use of the restraint;

    (B) time and date the restraint was used;

    (C) name of person administering the restraint;

    (D) type of restraint and duration used; and

    (E) if used in a behavioral emergency:

      (i) events preceding the use of the restraint;

      (ii) actions taken after the use of the restraint; and

      (iii) types of intervention attempted before the use of the restraint; and

  (7) in order to decrease the frequency of the use of restraint, and to minimize the risk of harm to an individual, must ensure that a service provider is aware of and adheres to the findings of the nursing assessment required in §42.212(c)(2) of this chapter (relating to Process for Enrollment of an Individual) or in §42.223(b)(1) of this chapter (relating to Periodic Review and Update of IPC and IPP) for each individual.

Source Note: The provisions of this §42.409 adopted to be effective January 1, 2015, 39 TexReg 6609

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