Section 22-A517. PROTECTIVE MEASURES

 

517.1Protective measures involve the use of gerichairs, chairs with trays, bed rails, straps, mitts or other devices which restrict freedom of movement or access to one's body in order to prevent falls, maintain posture and for other medical purposes.

 

517.2All MH providers may use protective measures in accordance with the requirements of this chapter.

 

517.3Protective measures shall be used only as a last resort when other adaptive or assistive devices, physical therapy, or environmental changes are inadequate to prevent injury to the consumer.

 

517.4The application of any protective measure that involves a physical restraint (a device, material, or apparatus that the consumer cannot easily remove) may only be applied in accordance with the procedures set forth in §§ 506.1 - 506.11 and §508 of this chapter. All other protective measures may be applied pursuant to the procedures set forth in this section.

 

517.5A RN may initiate the use of protective measures but shall obtain a verbal order from a physician or physician assistant, within one (1) hour of initiating protective measures. The initiation of protective measures shall be based on a documented assessment of the consumer's history and condition that indicates the strong probability that substantial harm to the consumer will occur in the absence of such measures.

 

517.6If the consumer is a minor or an adult who has a legal guardian, the MH provider staff shall notify the parent(s) or legal guardian(s) that the consumer has been placed in protective measures promptly after the initiation of these measures.

 

517.7Use of protective measures requires a written time limited order by the attending or treating physician. An order for protective measures may be written for up to twenty-four (24) hours.

 

517.8Scheduled observations for consumers in protective measures shall be made every fifteen (15) minutes and documented in the consumer's clinical record.

 

517.9Trained nursing staff shall periodically assess any consumer in protective measures. The protective measures shall be discontinued as soon as alternative measures for safety are feasible.

 

517.10Physical needs of consumers in protective measures shall be promptly met. The consumer's physical condition shall be assessed, and the opportunity for personal care, including fluids, bathroom use, range of motion, meals, and hygiene shall be provided and documented throughout the use of the protective measures. The consumer shall be monitored and assisted by:

 

(a)Recording the consumer's physical condition every fifteen (15) minutes;

 

(b)Assessing for safety, circulation and comfort every fifteen (15) minutes;

 

(c)Providing an opportunity for hourly access to the bathroom (or more often as appropriate) while the consumer is awake;

 

(d)Providing an opportunity for regular meals with any needed special precautions taken;

 

(e)Providing an opportunity for fluids at least every one (1) hour while the consumer is awake, with fluid type and amount recorded when consumed;

 

(f)Providing an opportunity for range of motion of extremities every two (2) hours while the consumer is awake; and

 

(g)Providing an opportunity for a bath or shower at least once each twenty- four (24) hours or more often when necessary.

 

517.11A service plan update is required for any consumer in protective measures in excess of twenty-four (24) hours. The service plan shall address the use of alternative interventions to reduce the need for protective measures.

 

517.12All protective devices shall be sanitized after each use.

 

517.13Protective devices shall only be used in a manner consistent with the manufacturer’s instructions for case and use of the devices.

 

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).