(a) The facility shall develop, implement, and enforce
policies and procedures that address the use of clinical timeout and
quiet time as preventive and de-escalating interventions to prevent
a behavioral emergency from occurring and to alleviate or otherwise
reduce the necessity for any use of restraint or seclusion.
(b) The policies and procedures shall include the following
requirements.
(1) Clinical timeout. A staff member may suggest that
an individual initiate clinical timeout.
(A) Prior to clinical timeout, the staff member suggesting
that an individual initiate clinical timeout shall explain to the
individual that clinical timeout is voluntary.
(B) Each time an individual uses clinical timeout,
a staff member shall document that use in the individual's medical
record.
(C) The facility's documentation of any use of clinical
timeout shall include a description of the conditions under which
the clinical timeout was suggested and the individual's response to
the suggestion.
(D) A decision by the individual to decline to begin,
or remain in, clinical timeout or similar interventions may not result
in the staff member's use of restraint or seclusion of the individual,
unless the initiation and use of the restraint or seclusion is permitted
under, and otherwise meets the requirements of, this subchapter. To
physically force or use personal restraint or coercion to direct the
individual to a clinical timeout areas or to prevent an individual
from leaving an area separated from other individuals receiving services,
constitutes a restraint and/or seclusion and renders the procedure
subject to the requirements for restraint or seclusion, as applicable,
described in this subchapter.
(2) Quiet time. An individual may request the use of
quiet time and, unless clinically contraindicated, be granted quiet
time.
(A) Under no circumstances may a staff member mandate
quiet time for an individual. If a staff member does so, or if the
individual wishes to terminate any self-initiated use of quiet time,
and a staff member requires the individual to remain, the situation
becomes a restraint and/or seclusion, as applicable, and becomes subject
to the requirements for restraint or seclusion, as applicable, described
in this subchapter.
(B) Unless a staff member terminates quiet time for
clinical reasons, the individual may terminate quiet time at any time.
Under no circumstances, except for clinical reasons, may a staff member
coerce or force a client out of quiet time. If a staff member does
so, the situation becomes a restraint and/or seclusion, and becomes
subject to the requirements for restraint or seclusion, as applicable,
described in this subchapter.
(C) On every occasion that quiet time is denied or
terminated for clinical reasons, a staff member shall document in
the medical record the conditions under which the quiet time was denied
or terminated.
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