|(a) If an assessment reveals non-violent, non-self-destructive
behavior, as defined in §415.253 of this title (relating to Definitions),
the facility shall use the least restrictive intervention that effectively
protects the individual from harm. If the intervention is a restraint
as defined in this subchapter, it shall only be used in the following
(1) medically necessary;
(2) ordered by a physician;
(3) needed to ensure the individual's safety; and
(4) used only after less restrictive interventions
have been considered, or attempted and determined to be ineffective,
or are judged to be unlikely to protect the individual or others from
(b) Prior to the application of a restraint for the
management of non-violent, non-self-destructive behavior, an assessment
of the individual shall be done to determine that the risks associated
with the use of the restraint are outweighed by the risks of not using
(c) The physician's order for the restraint shall specify:
(1) a time limit on the use of the restraint;
(2) any special considerations for the use of restraint;
(3) the specific type of restraint to be used;
(4) who is responsible for implementing the restraint;
(5) instructions for monitoring the individual.
(d) The physician shall renew the order as frequently
as determined by facility policy.
(e) The order for the restraint shall be followed by
consultation with the individual's treating physician if the restraint
was not ordered by the individual's treating physician. The consultation
shall be documented in the individual's medical record no later than
the next business day, except that it shall be done sooner, when an
earlier consultation is clinically indicated.
(f) The care of the individual shall be based on a
rationale that reflects consideration of the individual's medical
needs and health status.
(1) If the facility has made a clinical determination
that its use of restraint for the management of non-violent, non-self-destructive
behavior requires a frequency of assessment or an aspect of care or
treatment that differs from the provisions of this subchapter governing
restraint in a behavioral emergency, facility policies and procedures
on the use of restraint for the management of non-violent, non-self-destructive
behavior shall address:
(A) the facility's required frequency of assessment
of the individual during restraint; and
(B) how the individual's circulation, hydration, elimination,
level of distress and agitation, mental status, cognitive functioning,
cardiac functioning, skin integrity, nutrition, exercise, and range
of motion of extremities are to be assessed and addressed during restraint.
(2) The plan for monitoring the individual and the
rationale for the frequency of monitoring shall be documented in the
individual's medical record.
(g) A dentist at a facility, including any contractor
providing dental services on the facility premises shall not restrain
an individual for dental care or rehabilitation unless the restraint
is ordered by the individual's physician. The dentist shall maintain
a copy of the order in the individual's medical record and shall ensure
compliance with the requirements of the order.
(h) Whenever a restraint is ordered by a physician,
the ordering physician shall prescribe the frequency of assessment
required for the individual during restraint and how the individual's
circulation, hydration, elimination needs, level of distress and agitation,
mental status, cognitive functioning, cardiac functioning, skin integrity,
nutrition, exercise, and range of motion of extremities are to be
assessed and addressed during restraint.