Section 22-A508. MONITORING THE USE OF FOUR-POINT AND FIVE-POINT RESTRAINT OR SECLUSION

 

508.1Within one (1) hour after initiation of the use of restraint or seclusion and following the discontinuation of any restraints or seclusion of a consumer pursuant to this chapter, the physician or physician assistant shall conduct a face- to-face assessment of the physical, behavioral, mental, and emotional status of the consumer, including without limitation: 

 

(a)The consumer's physical, mental, and emotional state;

 

(b)The consumer's behavior;

 

(c)The appropriateness and effectiveness of the restraints or seclusion employed;

 

(d)Any complications resulting from the use of the restraint or seclusion; and

 

(e)Any medications ordered and the reasons for their use.

 

508.2Such examination shall be documented in the consumer's clinical record, including the date and time of the examination, the name of the individual making the examination, and the findings of the examination.

 

508.3In addition to an assessment by the consumer's physician or physician assistant, a trained and competent staff person shall, in person, continuously monitor and observe and regularly assess the consumer throughout the restraint or seclusion. This monitoring and assessment shall be documented and shall include at a minimum:

 

(a)Fifteen (15) minute assessments for signs of injury or medical distress;

 

(b)Hourly assessments of nutrition and hydration needs;

 

(c)Fifteen (15) minute assessments for circulation and hourly opportunities for range of motion in extremities;

 

(d)Elicitation of vital signs at implementation of restraints or seclusion, with vital sign checks every fifteen (15) minutes for the first thirty (30) minutes, and if stable, then hourly and then again upon release from restraints. If unable to elicit vital signs at any time, the staff shall document efforts to obtain vital signs and the reasons it could not be done;

 

(e)Hourly assessments of hygiene and elimination needs;

 

(f)Fifteen (15) minute assessments of mental health status; and

 

(g)Minimally, fifteen (15) minute assessments for readiness for discontinuation of restraints or seclusion.

 

508.4Remote observation of a consumer via video camera or other device or technique is not permissible to meet the requirements of § 508.3.

 

508.5The consumer shall be released from restraints and seclusion when there is an assessed stabilization of behavioral status such that the consumer no longer presents an imminent risk of serious injury to self or others, or when the order for restraints or seclusion expires and is not renewed, whichever is earlier,

 

508.6Restraints and seclusion may be terminated upon authorization of an RN, a physician or a physician assistant, except in the case of an emergency, when any staff may remove a consumer from restraints or seclusion to administer emergency treatment, evacuate the consumer from a hazardous condition such as fire or flood, or if for any reason the restraint or seclusion is causing harm to the consumer's physical health or safety.

 

authority

Sections 114 and 209 of the Mental Health Service Delivery Reform Act of 2001, effective December 18, 2001 (D.C. Law 14-56; D.C. Official Code §§ 7-1131.14 and 1231.09 (2001 ed.)).

source

Emergency and Proposed Rulemaking published at 51 DCR 8691 (September 3, 2004)[EXPIRED]; as amended by Emergency and Proposed Rulemaking published at 51 DCR 11863 (December 31, 2004)[EXPIRED]; as amended by Emergency and Proposed Rulemaking published at 52 DCR 5957 (June 24, 2005)[EXPIRED]; as amended by Final Rulemaking published at 52 DCR 7229 (August 5, 2005).