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RULE §415.259Special Considerations, Responsibilities, and Alternative Strategies

(a) Special considerations. Before ordering restraint or seclusion, the physician shall take the following into consideration:

  (1) information about the individual that could contraindicate or otherwise affect the use of restraint or seclusion;

  (2) information obtained during the initial assessment of each individual at the time of admission or intake, including, but not limited to:

    (A) pre-existing medical conditions or any physical disabilities and limitations, including, without limitation, cognitive functioning, substance use disorders, obesity, or pregnancy, that would place the individual at greater risk during restraint or seclusion;

    (B) any history of sexual abuse, physical abuse, neglect, trauma, or previous restraint or seclusion that would place the individual at greater psychological risk during restraint or seclusion;

    (C) any history or trauma that would contraindicate seclusion, the type of restraint (personal or mechanical), or a particular type of restraint device for the individual;

    (D) cultural factors; and

    (E) information contained in a declaration for mental health treatment, if there is one.

(b) Staff member responsibilities. Staff members shall:

  (1) respect and preserve the rights of an individual during restraint or seclusion. Rights of individuals are described in Chapter 404, Subchapter E of this title (relating to Rights of Persons Receiving Mental Health Services);

  (2) provide an environment that is protected and private from other individuals and that safeguards the personal dignity and well-being of an individual placed in restraint or seclusion;

  (3) ensure that undue physical discomfort, harm or pain to the individual does not occur when initiating or using restraint or seclusion;

  (4) use only the amount of physical force that is reasonable and necessary to implement a particular restraint or seclusion; and

  (5) use psychoactive medication in an emergency only in accordance with Chapter 414, Subchapter I of this title (relating to Consent to Treatment with Psychoactive Medication--Mental Health Services). Physically holding an individual during a forced administration of a psychoactive medication, including for court-ordered medication, constitutes personal restraint.

(c) Alternative strategies. The treatment team shall review and, when appropriate, implement and document alternative strategies for dealing with behaviors in each of the following circumstances:

  (1) in any case in which behaviors have necessitated the use of restraint or seclusion for the same individual more than two times during the individual's facility or program admission, or within any 30-day period, whichever period is shorter;

  (2) when two or more separate episodes of restraint or seclusion of any duration have occurred within the same 12 hour period; and

  (3) when an episode of restraint or seclusion has reached the maximum time permitted under §415.261(b) of this title (relating to Time Limitation on an Order for Restraint or Seclusion Initiated in Response to a Behavioral Emergency).

(d) Treatment plan modification. If the circumstances described in subsection (c)(1) - (3) of this section recur or continue after treatment team review of alternative strategies under subsection (c) of this section, the treatment team shall consult with the facility's chief medical physician administrator or designee to explore alternative treatment strategies and a written modification of the individual's treatment plan.

Source Note: The provisions of this §415.259 adopted to be effective July 22, 2014, 39 TexReg 5581

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