(49) Medical restraint plan--A component of the ISP
action plan that provides instructions for staff on how to effectively
and safely carry out medical restraint procedures. The plan is developed
with input from the PCP or dentist and meaningful input from the individual
and LAR and includes a description of the individual's behaviors that
do not allow for a safe and effective implementation of needed medical
or dental procedures, information about the types of restraints that
have been most effective with the individual, a description of the
criteria for releasing the restraint, and reporting requirements.
A medical restraint plan is not considered a therapeutic intervention
and may be adjusted depending upon the individual's progress in the
ISP action plan.
(50) Medication-related emergency--A situation in which
it is immediately necessary to administer medication to an individual
to prevent:
(A) imminent probable death or substantial bodily harm
to the individual because the individual:
(i) overtly or continually is threatening or attempting
to commit suicide or serious bodily harm; or
(ii) is behaving in a manner that indicates that the
individual is unable to satisfy the individual's need for nourishment,
essential medical care, or self-protection; or
(B) imminent physical or emotional harm to another
because of threats, attempts, or other acts the individual overtly
or continually makes or commits.
(51) Mental health services provider--Has the meaning
assigned in Texas Civil Practice and Remedies Code, Chapter 81.
(52) Neglect--An act or failure to act that, with regard
to an individual, meets the definition of "neglect" in Chapter
711, Subchapter A of this title (relating to Introduction), or the
definition of "neglect" in the CMS State Operations Manual,
Appendix J, Guidance to Surveyors: Intermediate Care Facilities for
Individuals with Intellectual Disabilities, available at www.cms.gov.
(53) Peer review--A review of clinical or professional
practice of a doctor, pharmacist, licensed vocational nurse, or registered
nurse conducted by his or her professional peers.
(54) Perpetrator--A person who has committed abuse,
neglect, or exploitation.
(55) Person--Includes a corporation, organization,
governmental subdivision or agency, or any other legal entity.
(56) Physical restraint--Any manual method that restricts
freedom of movement or normal access to one's body, including hand
or arm holding to escort an individual over his or her resistance
to being escorted. Physical restraint does not include brief and limited
use of physical guidance, positioning, or prompting techniques used
to redirect an individual or assist, support, or protect the individual
during a functional therapeutic or physical exercise activity; response
blocking and brief redirection used to interrupt an individual's limbs
or body without the use of force so that the occurrence of challenging
behavior is prevented; holding an individual, without the use of force,
to calm or comfort, or hand holding to escort an individual from one
area to another without resistance from the individual; and response
interruption used to interrupt an individual's behavior, using facility-approved
techniques.
(57) Physician on duty--The physician designated by
the facility's medical director to provide medical care or respond
to emergencies outside regular working hours.
(58) Positive behavior support plan (PBSP)--A comprehensive,
individualized plan that contains intervention strategies designed
to modify the environment, teach or increase adaptive skills, and
reduce or prevent the occurrence of target behaviors through interventions
that build on an individual's strengths and preferences, without using
aversive or punishment contingencies.
(59) Preponderance of the evidence--Evidence that is
of greater weight or more convincing than the evidence that is offered
in opposition to it; that is, evidence that, as a whole, shows that
the fact sought to be proved is more probable than not.
(60) Primary care provider (PCP)--A physician, advanced
practice registered nurse, or physician assistant who provides primary
care to a defined population of patients. The PCP is involved in health
promotion, disease prevention, health maintenance, and diagnosis and
treatment of acute and chronic illnesses.
(61) Prone restraint--Any physical or mechanical restraint
that places the individual in a face-down position. Prone restraint
does not include when an individual is placed in a face-down position
as a necessary part of a medical intervention, or when an individual
moves into a prone position during an incident of physical restraint,
if staff immediately begin an adjustment to restore the individual
to a standing, sitting, or side-lying position or, if that is not
possible, immediately release the person. Prone restraint is prohibited.
(62) Protection and advocacy organization--The protection
and advocacy system for Texas designated in accordance with the Code
of Federal Regulations, Title 45, §1326.20.
(63) Protective mechanical restraint for self-injurious
behavior--A type of mechanical restraint applied before an individual
engages in self-injurious behavior, for the purpose of preventing
or mitigating the danger of the self-injurious behavior because there
is evidence that the targeted behavior can result in serious self-injury
when it occurs and intensive, one-to-one supervision and treatment
have not yet reduced the danger of self-injury. Examples include,
but are not limited to, protective head gear for head banging, arm
splints for eye gouging, or mittens for hand-biting. The term does
not include medical restraints or protective devices.
(64) Protective mechanical restraint plan for self-injurious
behavior--A component of the ISP action plan that provides instructions
for staff on how to effectively and safely apply the protective mechanical
restraint that is used to prevent or mitigate the effects of serious
self-injurious behavior. The plan is developed with input from direct
support professionals familiar with the individual and meaningful
input from the individual and LAR, and includes a description of the
individual's self-injurious behaviors, the type of restraint to be
used, the restraint's maximum duration, and the circumstances to apply
and remove the restraint. The plan must identify any low-risk situations
when the restraint may be safely removed, what staff should do during
those situations to continue to protect the individual from harm,
and adjustments in staff instructions as progress is made for gradually
eliminating the use of the restraints, including details on any specialized
staff training and reporting. The plan is not considered a therapeutic
intervention and is adjusted depending upon the individual's progress
in the ISP action plan and an evaluation by the PCP that the individual's
behavior is no longer at the dangerous level that is producing serious
self-injury.
(65) Psychotropic medication--A medication that is
prescribed for the treatment of symptoms of psychosis or other severe
mental or emotional disorder and that is used to exercise an effect
on the central nervous system to influence and modify behavior, cognition,
or affective state when treating the symptoms of mental illness. Psychotropic
medication, sometimes referred to as "psychoactive medication,"
includes the following categories of medication:
(A) antipsychotics or neuroleptics;
(B) antidepressants;
(C) agents for control of mania or depression;
(D) antianxiety agents;
(E) sedatives, hypnotics, or other sleep-promoting
drugs; and
(F) psychomotor stimulants.
(66) Registered nurse--A nurse licensed by the Texas
Board of Nursing to practice professional nursing in Texas.
(67) Registries--
(A) The Nurse Aide Registry maintained by DADS in accordance
with §94.12 of this title (relating to Findings and Inquiries);
and
(B) The Employee Misconduct Registry maintained by
DADS in accordance with Chapter 93 of this title (relating to Employee
Misconduct Registry (EMR)).
(68) Reporter--A person who reports an allegation of
abuse, neglect, or exploitation.
(69) Restraint monitor--A designated facility employee
who has received competency-based training and demonstrated proficiency
in the application and assessment of restraints, who has experience
working directly with individuals with developmental disabilities,
and who is trained to conduct a face-to-face assessment of the individual
who was restrained and the staff involved in the restraint to review
the application and results of the restraint.
(70) Retaliation--An action intended to inflict emotional
or physical harm or inconvenience on a person including harassment,
disciplinary action, discrimination, reprimand, threat, and criticism.
(71) SSLC--A state supported living center.
Cont'd... |