| (a) Protective Devices. A center must ensure that a
protective device is used only as ordered by a minor's physician,
as agreed to by an adult minor or a minor's parent, and in accordance
with the minor's plan of care.
(1) A center may use a protective device only in the
following circumstances:
(A) as part of a therapeutic regimen of basic services
for a minor's physical health and development;
(B) during medical, nursing, diagnostic, and dental
procedures as prescribed by a physician's order and to protect the
health and safety of a minor; or
(C) in a medical emergency to protect the health and
safety of a minor.
(2) A center must adopt and enforce written policies
and procedures requiring a protective device to be used as described
in this subsection and in accordance with a minor's plan of care.
(3) A center must not implement a physician's order
for the use of a protective device on a pro re nata (PRN) or as-needed
basis.
(4) A center must ensure a physician's order is obtained
before using a protective device at the center. The physician's order
must include:
(A) the circumstances under which a protective device
may be used at the center;
(B) instructions on how long a protective device may
be used at the center; and
(C) any individualized, less restrictive interventions
described in the minor's plan of care that must be used before using
a protective device.
(5) A center must ensure that in implementing a physician's
order for a protective device that an RN, with input from an adult
minor, a minor's parent, and the IDT:
(A) conducts an assessment of a minor's current and
ongoing need for a protective device at a center;
(B) reviews the physician's order for a protective
device, as described in paragraph (4) of this subsection; and
(C) obtains and documents in a minor's medical record
the written consent of an adult minor or a minor's parent to use a
protective device at the center.
(6) Before using a protective device for the first
time with a minor, the center must ensure an RN provides oral and
written notification to the adult minor or the minor's parent of the
right at any time to withdraw consent and discontinue use of a protective
device at the center.
(7) The center must ensure that a staff member who
will apply a protective device has been properly trained in the use
of a protective device, as ordered in the minor's plan of care, in
accordance with this subsection, and in accordance with §15.415(b)(8)(F)
of this subchapter (relating to Staffing Policies for Staff Orientation,
Development, and Training).
(8) If a protective device is used for a minor, the
center must ensure:
(A) the minor is assessed by an RN, in accordance
with the physician's order but no less than once every hour to determine
if the protective device must be repositioned or discontinued;
(B) except for sedation, the protective device is removed
to conduct the RN assessment described in subparagraph (A) of this
paragraph and removed more frequently as determined necessary by the
RN's assessment;
(C) center staff replaces the protective device, if
necessary, after the assessment, in accordance with the physician's
order;
(D) a minor's physician is notified immediately if
an assessment determines a change in the minor's condition or a negative
reaction to the protective device has occurred, including notification
of:
(i) the minor's psychosocial condition;
(ii) the minor's reaction to the protective device;
(iii) the minor's medical condition; and
(iv) the need to continue or discontinue the use of
the protective device;
(E) the type and frequency of use of the protective
device is documented in the minor's medical record;
(F) the effects of a protective device on the minor's
health and welfare are evaluated and documented in the medical record;
and
(G) an RN, an adult minor, a minor's parent, and the
IDT, at least every 180 days, or as the minor's needs change, review,
with input and direction from the minor's prescribing physician,
the use of a protective device to determine its effectiveness and
the need to continue the use of the protective device.
(b) Restraints. A center may use a restraint only in
a behavioral emergency when the immediate health and safety of the
minor or another minor are at risk. A center must not use a chemical
or mechanical restraint. A center may use only the following restraints:
(1) The center must adopt and enforce a written policy
and procedures regarding the use of restraints in a behavioral emergency,
including whether a center is a restraint-free environment.
(2) A center must ensure that the use of a restraint
at a center must not be in a manner that:
(A) obstructs a minor's airway, including the placement
of anything in, on, or over the minor's mouth or nose;
(B) impairs the minor's breathing by putting pressure
on the minor's torso;
(C) interferes with the minor's ability to communicate;
(D) extends muscle groups away from each other;
(E) uses hyperextension of joints; or
(F) uses pressure points or pain.
(3) A center must ensure that a restraint is not used
for:
(A) controlling a minor's behavior in a non-emergency;
(B) negative discipline as described in §15.206
of this division (relating to Person-Centered Direction and Guidance);
(C) convenience;
(D) coercion or retaliation; or
(E) as part of a behavior component of a minor's psychosocial
program.
(4) A center must not implement a physician's order
for the use of a restraint on a pro re nata (PRN) or as-needed basis.
(5) A center must ensure that a staff member whose
job responsibilities will include the use or application of a restraint
during a behavioral emergency has been properly trained in the use
of a restraint for minors served at the center, in accordance with
this section, and in accordance with §15.415(b)(8)(G) of this
subchapter (relating to Staffing Policies for Staff Orientation,
Development, and Training).
(6) If a center restrains a minor due to a behavioral
emergency, the center must ensure:
(A) all less restrictive options available are exhausted
before using a restraint;
(B) the restraint is limited to the use of such reasonable
force as is necessary to address the emergency;
(C) the restraint is discontinued immediately at the
point when the emergency no longer exists but no more than 15 minutes
after the restraint was initiated;
(D) the restraint is implemented in such a way as to
protect the health and safety of the minor and others;
(E) immediately after the restraint is discontinued,
the minor is assessed by an RN;
(F) immediately following an RN assessment, medical
attention is provided for the minor if determined necessary by the
RN assessment;
(G) within three days after the use of the restraint,
an assessment is conducted by an RN as described in §15.504 of
this chapter (relating to Psychosocial Treatment and Services) to
determine if the development and implementation of a psychosocial
treatment and services program is needed for the minor to address
the minor's behavior and reduce the occurrence of future behavioral
emergencies; and
(H) within three days after the use of the restraint,
an RN reviews and updates a minor's plan of care and psychosocial
treatment and services program as determined appropriate.
(7) If a center restrains a minor due to a behavioral
emergency, the center must ensure the following documentation and
notifications occur:
(A) immediately after the restraint is discontinued,
information about the restraint is documented, including:
(i) the name of the individual who administered the
restraint;
(ii) the date and time the restraint began and ended;
(iii) the location of the restraint;
(iv) the nature of the restraint;
(v) a description of the setting and activity in which
the minor was engaged immediately preceding the use of the restraint;
(vi) the behavior that prompted the restraint;
(vii) the efforts made to de-escalate the situation
and the less restrictive alternatives attempted before the restraint;
and
Cont'd... |
