Ariz. Admin. Code § R9-10-515 - Seclusion; Restraint
A. An
administrator shall ensure that:
1. An
ICF/IID's policies and procedures for managing a resident's inappropriate
behavior, as described in
R9-10-503(C)(2)(g)
are reviewed, approved, and monitored through the quality management process in
R9-10-504;
and
2. Restraint is provided
according to the requirements in subsection (C).
B. An administrator of an ICF/IID authorized
to provide seclusion shall ensure that:
1.
Seclusion is provided according to the requirements in subsection
(C);
2. If a resident is placed in
seclusion, the room used for seclusion:
a. Is
approved for use as a seclusion room by the Department;
b. Is not used as a resident's bedroom or a
sleeping area;
c. Allows full view
of the resident in all areas of the room;
d. Is free of hazards, such as unprotected
light fixtures or electrical outlets;
e. Contains at least 60 square feet of floor
space; and
f. Except as provided in
subsection (B)(3), contains a non-adjustable bed that:
i. Consists of a mattress on a solid platform
that is:
(1) Constructed of a durable,
non-hazardous material; and
(2)
Raised off of the floor;
ii. Does not have wire springs or a storage
drawer; and
iii. Is securely
anchored in place;
3. If a room used for seclusion does not
contain a non-adjustable bed required in subsection (B)(2)(f):
a. A piece of equipment is available that:
i. Is commercially manufactured to safely and
humanely restrain a resident's body;
ii. Provides support to the trunk and head of
a resident's body;
iii. Provides
restraint to the trunk of a resident's body;
iv. Is able to restrict movement of a
resident's arms, legs, body, and head;
v. Allows a resident's body to recline;
and
vi. Does not inflict harm on a
resident's body; and
b.
Documentation of the manufacturer's specifications for the piece of equipment
in subsection (B)(3)(a) is maintained; and
4. A seclusion room may be used for services
or activities other than seclusion if:
a. A
sign stating the service or activity scheduled or being provided in the room is
conspicuously posted outside the room;
b. No permanent equipment other than the bed
required in subsection (B)(2)(f) is in the room;
c. Policies and procedures:
i. Delineate which services or activities
other than seclusion may be provided in the room,
ii. List what types of equipment or supplies
may be placed in the room for the delineated services, and
iii. Provide for the prompt removal of
equipment and supplies from the room before the room is used for seclusion;
and
d. The sign required
in subsection (B)(4)(a) and equipment and supplies in the room, other than the
bed required in subsection (B)(2)(f), are removed before use as a seclusion
room.
C. An
administrator shall ensure that:
1. Policies
and procedures for providing restraint or seclusion are established,
documented, and implemented to protect the health and safety of a resident
that:
a. Establish the process for resident
assessment, including identification of a resident's medical conditions and
criteria for the on-going monitoring of any identified medical
condition;
b. Identify each type of
restraint or seclusion used and include for each type of restraint or seclusion
used:
i. The qualifications of a personnel
member who can:
(1) Order the restraint or
seclusion,
(2) Place a resident in
the restraint or seclusion,
(3)
Monitor a resident in the restraint or seclusion,
(4) Evaluate a resident's physical and
psychological well-being after being placed in the restraint or seclusion and
when released from the restraint or seclusion, or
(5) Renew the order for restraint or
seclusion;
ii. On-going
training requirements for a personnel member who has direct resident contact
while the resident is in a restraint or seclusion; and
iii. Criteria for monitoring and assessing a
resident including:
(1) Frequencies of
monitoring and assessment based on a resident's medical condition and risks
associated with the specific restraint or seclusion;
(2) For the renewal of an order for restraint
or seclusion, whether an assessment is required before the order is renewed
and, if an assessment is required, who may conduct the assessment;
(3) Assessment content, which may include,
depending on a resident's condition, the resident's vital signs, respiration,
circulation, hydration needs, elimination needs, level of distress and
agitation, mental status, cognitive functioning, neurological functioning, and
skin integrity;
(4) If a mechanical
restraint is used, how often the mechanical restraint is loosened;
and
(5) A process for meeting a
resident's nutritional needs and elimination needs;
c. Establish the criteria and
procedures for renewing an order for restraint or seclusion;
d. Establish procedures for internal review
of the use of restraint or seclusion; and
e. Establish medical record and personnel
record documentation requirements for restraint and seclusion, if
applicable;
2. An order
for restraint or seclusion is:
a. Obtained
from a physician or registered nurse practitioner, and
b. Not written as a standing order or on an
as-needed basis;
3.
Restraint or seclusion is:
a. Not used as a
means of coercion, discipline, convenience, or retaliation;
b. Only used when all of the following
conditions are met:
i. Except as provided in
subsection (C)(4), after obtaining an order for the restraint or seclusion;
ii. For the management of a
resident's aggressive, violent, or self-destructive behavior;
iii. When less restrictive interventions have
been determined to be ineffective; and
iv. To ensure the immediate physical safety
of the resident, to prevent imminent harm to the resident or another
individual, or to stop physical harm to another individual; and
c. Discontinued at the earliest
possible time;
4. If as
a result of a resident's aggressive, violent, or self-destructive behavior,
harm to the resident or another individual is imminent or the resident or
another individual is being physically harmed, a personnel member:
a. May initiate an emergency application of
restraint or seclusion for the resident before obtaining an order for the
restraint or seclusion, and
b.
Obtains an order for the restraint or seclusion of the resident during the
emergency application of the restraint or seclusion;
5. An order for restraint or seclusion
includes:
a. The name of the physician or
registered nurse practitioner ordering the restraint or seclusion;
b. The date and time that the restraint or
seclusion was ordered;
c. The
specific restraint or seclusion ordered;
d. If a drug is ordered as a chemical
restraint, the drug's name, strength, dosage, and route of
administration;
e. The specific
criteria for release from restraint or seclusion without an additional order;
and
f. The maximum duration
authorized for the restraint or seclusion;
6. An order for restraint or seclusion is
limited to the duration of the emergency situation and does not exceed three
continuous hours;
7. If an order
for restraint or seclusion of a resident is not provided by the resident's
attending physician, the resident's attending physician is notified as soon as
possible;
8. A medical practitioner
or personnel member does not participate in restraint or seclusion, assess or
monitor a resident during restraint or seclusion, or evaluate a resident after
restraint or seclusion, and a physician or registered nurse practitioner does
not order restraint or seclusion, until the medical practitioner or personnel
member, completes education and training that:
a. Includes:
i. Techniques to identify medical
practitioner, personnel member, and resident behaviors, events, and
environmental factors that may trigger circumstances that require restraint or
seclusion;
ii. The use of
nonphysical intervention skills, such as de-escalation, mediation, conflict
resolution, active listening, and verbal and observational methods;
iii. Techniques for identifying the least
restrictive intervention based on an assessment of the resident's medical or
behavioral health condition;
iv.
The safe use of restraint and the safe use of seclusion, including training in
how to recognize and respond to signs of physical and psychological distress in
a resident who is restrained or secluded;
v. Clinical identification of specific
behavioral changes that indicate that the restraint or seclusion is no longer
necessary;
vi. Monitoring and
assessing a resident while the resident is in restraint or seclusion according
to policies and procedures; and
vii. Except for the medical practitioner,
training exercises in which the personnel member successfully demonstrates the
techniques that the medical practitioner or personnel member has learned for
managing emergency situations; and
b. Is provided by individuals qualified
according to policies and procedures;
9. When a resident is placed in restraint or
seclusion:
a. The restraint or seclusion is
conducted according to policies and procedures;
b. The restraint or seclusion is
proportionate and appropriate to the severity of the resident's behavior and
the resident's:
i. Chronological and
developmental age;
ii.
Size;
iii. Gender;
iv. Physical condition;
v. Medical condition;
vi. Psychiatric condition; and
vii. Personal history, including any history
of physical or sexual abuse;
c. The physician or registered nurse
practitioner who ordered the restraint or seclusion is available for
consultation throughout the duration of the restraint or seclusion;
d. The resident is monitored and assessed
according to policies and procedures;
e. A physician or registered nurse assesses
the resident within one hour after the resident is placed in the restraint or
seclusion and determines:
i. The resident's
current behavior,
ii. The
resident's reaction to the restraint or seclusion used,
iii. The resident's medical and behavioral
condition, and
iv. Whether to
continue or terminate the restraint or seclusion;
f. The resident is given the opportunity:
i. To eat during mealtime, and
ii. To use the toilet; and
g. The restraint or seclusion is
discontinued at the earliest possible time, regardless of the length of time
identified in the order;
10. A medical practitioner or personnel
member documents the following information in a resident's medical record
before the end of the shift in which the resident is placed in restraint or
seclusion or, if the resident's restraint or seclusion does not end during the
shift in which it began, during the shift in which the resident's restraint or
seclusion ends:
a. The emergency situation
that required the resident to be restrained or put in seclusion,
b. The times the resident's restraint or
seclusion actually began and ended,
c. The monitoring required in subsection
(C)(9)(d),
d. The time of the
assessment required in subsection (C)(9)(e),
e. The names of the medical practitioners and
personnel members with direct resident contact while the resident was in the
restraint or seclusion,
f. The
times the resident was given the opportunity to eat or use the toilet according
to subsection (C)(9)(f), and
g. The
resident evaluation required in subsection (C)(12);
11. If an emergency situation continues
beyond the time limit of an order for restraint or seclusion, the order is
renewed according to policies and procedures that include:
a. The specific criteria for release from
restraint or seclusion without an additional order, and
b. The maximum duration authorized for the
restraint or seclusion; and
12. A resident is evaluated after restraint
or seclusion is no longer being used for the resident.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.