| (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
(G) the use of first-aid techniques and certification
in the use of cardiopulmonary resuscitation, including required periodic
recertification.
(3) Persons providing staff training must be qualified
as evidenced by education, training, and experience in techniques
used to address a client's behaviors.
(4) A hospice must document in the staff personnel
records that the training and demonstration of competency were successfully
completed.
(n) Death reporting requirements. A hospice must report
deaths associated with the use of seclusion or restraint in its inpatient
unit.
(1) The hospice must report:
(A) an unexpected death that occurs while a client
is in restraint or seclusion;
(B) an unexpected death that occurs within 24 hours
after the client has been removed from restraint or seclusion; and
(C) a death known to the hospice that occurs within
one week after restraint or seclusion where it is reasonable to assume
that use of restraint or placement in seclusion contributed directly
or indirectly to the client's death. The term "reasonable to assume"
in this context includes but is not limited to death related to restrictions
of movement for prolonged periods of time, or death related to chest
compression, restriction of breathing, or asphyxiation.
(2) The hospice must report a death described in paragraph
(1) of this subsection to HHSC by telephone at 1-800-458-9858 within
24 hours after knowledge of a client's death.
(3) The hospice must complete Provider Investigation
Report For Home and Community Support Services Agency (HHSC Form 3613)
and send it to HHSC Complaint Intake Unit within 10 days after reporting
the death to HHSC by telephone.
(4) Hospice personnel must document in the client's
record the date and time the death was reported to HHSC.
|
| Source Note: The provisions of this §558.871 adopted to be effective October 1, 2013, 38 TexReg 6628; transferred effective May 1, 2019, as published in the April 12, 2019 issue of the Texas Register, 44 TexReg 1893; amended to be effective April 25, 2021, 46 TexReg 2427 |
