The following words and terms, when used in this subchapter,
shall have the following meanings, unless the context clearly indicates
(1) Advanced practice registered nurse or APRN--A registered
nurse authorized by the Texas Board of Nursing to practice as an advanced
practice registered nurse.
(2) Behavioral emergency--A situation involving an
individual who is behaving in a violent or self-destructive manner
and in which preventive, de-escalative, or verbal techniques have
been determined to be ineffective and it is immediately necessary
to restrain or seclude the individual to prevent:
(A) imminent probable death or substantial bodily harm
to the individual because the individual is attempting to commit suicide
or inflict serious bodily harm; or
(B) imminent physical harm to others because of acts
the individual commits.
(3) Chemical restraint--The use of any chemical, including
pharmaceuticals, through topical application, oral administration,
injection, or other means, for purposes of restraining an individual
and which is not a standard treatment for the individual's medical
or psychiatric condition.
(4) Chief executive officer (CEO)--The highest ranking
administrator of a facility or such person's designee.
(5) Clinical timeout--A procedure in which an individual,
in response to verbal suggestion from a staff member, voluntarily
enters and remains for a period of time in a designated area from
which the individual is not prevented from leaving.
(6) Competence--Demonstrated knowledge, skill, and
(7) Continuous face-to-face observation--An in-person
line of sight that is maintained in an uninterrupted manner and is
free of distraction.
(8) Declaration for mental health treatment--A document
making a statement of preferences or instructions for mental health
treatment as set forth in Texas Civil Practice and Remedies Code,
(9) DSHS--The Department of State Health Services.
(10) Emergency medical condition--A non-psychiatric
medical condition manifesting itself by acute symptoms, including
severe pain, of sufficient severity such that the absence of immediate
medical attention could reasonably be expected to result in serious
impairment to bodily functions, serious dysfunction of any bodily
organ or part, or a threat to the health or safety of a pregnant woman
or her unborn child.
(11) Emergency medication--A psychoactive medication
that is used to treat the signs and symptoms of mental illness in
a psychiatric emergency, as that term is defined in Chapter 415, Subchapter
A of this title (relating to Prescribing of Psychoactive Medication),
when other interventions are ineffective or inappropriate.
(12) Episode--The time period from the initiation of
restraint or seclusion until the release of the individual.
(13) Face-to-face--Describes a contact with an individual
that occurs in person. Face-to-face does not include a contact made
through the use of video or telecommunication conferencing or technologies,
(14) Facility--An entity to which this subchapter applies
as identified in §415.252 of this title (relating to Application).
(15) Individual--Any person receiving mental health
services from a facility.
(16) Initiate--The first overt act to restrain or seclude
(17) Legally authorized representative (LAR)--A person
authorized by law to act on behalf of an individual with regard to
a matter described in this subchapter, and who may include a parent,
guardian, or managing conservator of a minor individual; guardian
of the person of an adult individual; or person with activated power
of attorney for health care decisions.
(18) Mechanical restraint--Any device, material, or
equipment that immobilizes or reduces the ability of the individual
to move his or her arms, legs, body, or head freely.
(19) Mental health services--All services concerned
with research, prevention, and detection of mental disorders and disabilities,
and all services necessary to treat, care for, control, supervise,
and rehabilitate persons who have a mental disorder or disability,
including persons whose mental disorders or disabilities result from
alcoholism or drug addiction.
(20) Non-violent, non-self-destructive behavior--Behavior
related to a non-psychiatric medical condition or symptom that indicates
the need for an intervention to protect the individual from harm.
(21) Personal restraint--Any manual method by which
a person holds or otherwise bodily applies physical pressure that
immobilizes or reduces the ability of the individual to move his or
her body or a portion of his or her body.
(22) Physician assistant--A person who is licensed
under Texas Occupations Code, Chapter 204.
(23) PRN--As needed (pro re nata).
(24) Protective device--A device used to prevent injury
or to permit wounds to heal.
(25) Quiet time--A procedure in which an individual,
on the individual's own initiative, enters and remains for a period
of time in a designated area from which the individual is not prevented
(26) Registered nurse--A person who is licensed under
Texas Occupations Code, Chapter 301, and who has demonstrated the
clinical competencies required by this subchapter.
(27) Restraint--The use of any personal restraint or
mechanical restraint that immobilizes or reduces the ability of the
individual to move his or her arms, legs, body, or head freely.
(28) Seclusion--The involuntary separation of an individual
from other individuals for any period of time and or the placement
of the individual alone in an area from which the individual is prevented
(29) Seclusion room--A hazard-free room or other area
in which direct observation of an individual can be maintained and
from which the individual is prevented from leaving.
(30) Serious injury--An injury determined by a physician
to require medical treatment by a licensed medical professional (e.g.,
physician, osteopath, dentist, physician's assistant, or advance practice
nurse), or requires medical treatment in an emergency department or
(31) Staff member--A person directly involved in an
individual's care, including professionals who are credentialed and
granted privileges by the facility, full-time and part-time employees,
(32) Supportive device--A device voluntarily used by
an individual to posturally support the individual or to assist the
individual who cannot obtain or maintain normal bodily functioning.
(33) Treating physician--The physician assigned by
the facility and designated in the individual's medical record as
the physician responsible for the coordination and oversight of the
implementation of an individual's comprehensive treatment plan and
(A) licensed as a physician by the Texas Medical Board
in accordance with Texas Occupations Code, Chapter 155; or
(B) authorized to perform medical acts under an institutional
permit at a Texas postgraduate training program approved by the Accreditation
Council for Graduate Medical Education, the American Osteopathic Association,
or the Texas Medical Board.
(34) Treatment team--A group of staff members, the
individual, and LAR (if any) who work together in a coordinated manner
for the purpose of providing comprehensive mental health services
to an individual.