| (2) have plumbing fixtures with control valves that
automatically regulate the temperature of the hot water used by a
client.
(h) Infection control. A hospice inpatient unit must
maintain an infection control program that protects clients, staff,
and others by preventing and controlling infections and communicable
disease in accordance with §558.853 of this subchapter (relating
to Hospice Infection Control Program).
(i) Sanitary environment. A hospice inpatient unit
must provide a sanitary environment by following accepted standards
of practice, including nationally recognized infection control precautions,
and avoiding sources and transmission of infections and communicable
diseases.
(j) Linen. A hospice inpatient unit must always have
available a quantity of clean linen in sufficient amounts for a client's
use. Linens must be handled, stored, processed, and transported in
such a manner as to prevent the spread of contaminants.
(k) Meal service and menu planning. A hospice inpatient
unit must furnish meals to a client that are:
(1) consistent with the client's plan of care, nutritional
needs, and therapeutic diet;
(2) palatable, attractive, and served at the proper
temperature; and
(3) obtained, stored, prepared, distributed, and served
under sanitary conditions.
(l) Use of restraint or seclusion. A client in a hospice
inpatient unit has the right to be free from restraint or seclusion,
of any form, imposed as a means of coercion, discipline, convenience,
or retaliation by staff. Restraint or seclusion may only be imposed
to ensure the immediate physical safety of the client, a staff member,
or others and must be discontinued at the earliest possible time.
(1) Restraint or seclusion may only be used when less
restrictive interventions are determined to be ineffective to protect
the client, a staff member, or others from harm.
(2) The type or technique of restraint or seclusion
used must be the least restrictive intervention that is effective
to protect the client, a staff member, or others from harm.
(3) The use of restraint or seclusion must be:
(A) in accordance with a written modification to the
client's plan of care; and
(B) implemented in accordance with safe and appropriate
restraint and seclusion techniques as determined by hospice policy.
(4) The use of restraint or seclusion must be in accordance
with the order of a physician authorized to order restraint or seclusion
by hospice policy.
(5) An order for the use of restraint or seclusion
must never be written as a standing order or on an as needed basis.
(6) The medical director or physician designee must
be consulted as soon as possible if the attending practitioner did
not order the restraint or seclusion.
(7) An order for restraint or seclusion used for the
management of violent or self-destructive behavior that jeopardizes
the immediate physical safety of the client, a staff member, or others
may only be renewed in accordance with the following limits for up
to a total of 24 hours:
(A) four hours for adults 18 years of age or older;
(B) two hours for children and adolescents nine to
17 years of age; or
(C) one hour for children under nine years of age.
(8) After 24 hours, before writing a new order for
the use of restraint or seclusion for the management of violent or
self-destructive behavior, a physician authorized to order restraint
or seclusion by hospice policy must see and assess the client.
(9) Each order for restraint used to ensure the physical
safety of a non-violent or non-self-destructive client may be renewed
as authorized by hospice policy.
(10) Restraint or seclusion must be discontinued at
the earliest possible time, regardless of the length of time identified
in the order.
(11) The condition of the client who is restrained
or secluded must be monitored by a physician or trained staff who
have completed the training criteria specified in subsection (o) of
this section at an interval determined by hospice policy.
(12) Training requirements for a physician and for
an attending practitioner must be specified in hospice policy. At
a minimum, a physician and an attending practitioner authorized to
order restraint or seclusion by hospice policy must have a working
knowledge of hospice policy regarding the use of restraint or seclusion.
(13) When restraint or seclusion is used for the management
of violent or self-destructive behavior that jeopardizes the immediate
physical safety of the client, a staff member, or others:
(A) the client must be seen face-to-face within one
hour after the initiation of the intervention by a physician or RN
who has been trained in accordance with the requirements specified
in subsection (m) of this section; and
(B) the physician or RN must evaluate:
(i) the client's immediate situation;
(ii) the client's reaction to the intervention;
(iii) the client's medical and behavioral condition;
and
(iv) the need to continue or terminate the restraint
or seclusion.
(14) If the face-to-face evaluation specified in paragraph
(13) of this subsection is conducted by a trained RN, the trained
RN must consult the medical director or physician designee as soon
as possible after the completion of the one-hour face-to-face evaluation.
(15) All requirements specified under this paragraph
are applicable to the simultaneous use of restraint and seclusion.
Simultaneous restraint and seclusion is only permitted if the client
is continually monitored:
(A) face-to-face by an assigned, trained staff member;
or
(B) by trained staff using both video and audio equipment.
This monitoring must be close to the client.
(16) When restraint or seclusion is used, there must
be documentation in the client's record of:
(A) the one-hour face-to-face medical and behavioral
evaluation if restraint or seclusion is used to manage violent or
self-destructive behavior;
(B) a description of the client's behavior and the
intervention used;
(C) alternatives or other less restrictive interventions
attempted, if applicable;
(D) the client's condition or symptoms that warranted
the use of the restraint or seclusion; and
(E) the client's response to the interventions used,
including the rationale for continued use of the intervention.
(m) Restraint or seclusion staff training requirements.
A client has the right to safe implementation of restraint or seclusion
by trained staff.
(1) Client care staff working in the hospice inpatient
unit must be trained and able to demonstrate competency in the application
of restraints, implementation of seclusion, monitoring, assessment,
and providing care for a client in restraint or seclusion:
(A) before performing any of the actions specified
in paragraph (1) of this subsection;
(B) as part of orientation; and
(C) subsequently on a periodic basis consistent with
hospice policy.
(2) A hospice must require appropriate staff to have
education, training, and demonstrated knowledge based on the specific
needs of the client population in:
(A) techniques to identify staff and client behaviors,
events, and environmental factors that may trigger circumstances that
require the use of a restraint or seclusion;
(B) the use of nonphysical intervention skills;
(C) choosing the least restrictive intervention based
on an individualized assessment of the client's medical or behavioral
status or condition;
(D) the safe application and use of all types of restraint
or seclusion used in the hospice, including training in how to recognize
and respond to signs of physical and psychological distress (for example,
positional asphyxia);
(E) clinical identification of specific behavioral
changes that indicate that restraint or seclusion is no longer necessary;
(F) monitoring the physical and psychological well-being
of a client who is restrained or secluded, including but not limited
to respiratory and circulatory status, skin integrity, vital signs,
and any special requirements specified by hospice policy associated
with the one-hour face-to-face evaluation; and
Cont'd... |
