Section 330.7243. Restraint seclusion, and physical management.

(1) A provider shall  keep  a  separate,  permanent chronological record specifically identifying all instances when restraint or seclusion has been used. The record  shall  include all  of  the following information:

(a)  The name of the recipient.

(b)   The type of restraint or conditions of seclusion.

(c)   The name of the authorizing and ordering physician.

(d)  The date and  time  placed  in  temporary,  authorized,   and    ordered restraint or seclusion.

(e)  The date  and  time  the  recipient   was  removed  from  temporary, authorized, and ordered restraint or seclusion.

(2)   A recipient who is in restraint or seclusion shall be inspected at least once every 15 minutes by designated personnel.

(3)    A provider shall ensure that documentation of staff monitoring and observation is entered into the medical record of the recipient.

(4)   A recipient in restraint or seclusion shall be provided hourly access to a toilet.

(5)   A recipient in restraint or seclusion shall have an opportunity to bathe, or shall be bathed as often as needed, but  at  least  once every 24 hours.

(6)    If an order for restraint or seclusion is to expire and the continued use of restraint or seclusion is clinically indicated and must be extended, then a physician's reauthorization or reordering of restraint or seclusion shall comply with both of the following provisions:

(a)   If the restraint device is a cloth vest and is used to limit the resident's movement at night to prevent the recipient from injuring himself or herself in bed, the physician may reauthorize or reorder the continued use of the cloth vest device pursuant to section 740(4) and(5) of the act.

(b)   Except as specified in subdivision (a) of this subrule,  a   physician who orders or reorders restraint or seclusion shall do so in accordance with sections 740(5) and 742(5) of the act. The required examination by a physician shall be conducted   not more than 30 minutes before the expiration of the expiring order for restraint or seclusion.

(7)   If a recipient is removed from restraint or seclusion for more than 30 minutes, then the order or authorization shall terminate.

(8)   A provider shall ensure that a secluded or restrained recipient is given an explanation of why he or she is being secluded or  restrained  and what  he or she needs to do to have the restraint or seclusion order removed. The explanation shall be provided in  clear  behavioral  terms  and documented in the record.

(9)    For restrained recipients, a provider shall ensure that an assessment of the circulation status of restrained limbs is conducted and documented at 15-minute intervals or more often if medically indicated.

(10)     For purposes of  this   rule,  a  time  out  or  therapeutic de-escalation program, as defined in R 330.7001, is not a form of seclusion.

(11)   Physical management as defined in R 330.7001 (m) may only be used in situations when a recipient is presenting an imminent risk of serious or non-serious physical  harm   to  himself,  herself    or   others    and lesser restrictive interventions have been unsuccessful in reducing or eliminating the imminent risk of serious or non-serious physical  harm. Both of the following shall apply:

(i)   Physical management shall not be included as a component in a behavior treatment plan.

(ii)   Prone immobilization of a recipient for the purpose of behavior control is prohibited unless implementation of physical management techniques other than prone immobilization is medically contraindicated  and   documented in  the recipient's record.

History: 1979 AC; 1981 AACS; 1983 AACS; 1984 AACS; 1998 AACS; 2007 AACS; 2009 AACS.