Each resident shall receive kind and considerate care at all
times and shall be free from mental, physical, sexual, and verbal abuse,
exploitation, neglect, and physical injury. Each resident shall be free from
chemical and physical restraints except as follows: when authorized in writing
by a physician for a specified period of time; when necessary in an emergency
to protect the resident from injury to the resident or to others, in which case
restraints may be authorized by designated professional personnel who promptly
report the action taken to the physician; and in the case of an intellectually
disabled individual when ordered in writing by a physician and authorized by a
designated qualified intellectual disabilities professional for use during
behavior modification sessions. Mechanical supports used in normative
situations to achieve proper body position and balance shall not be considered
to be a restraint. (II)
(1) Mental
abuse includes, but is not limited to, humiliation, harassment, and threats of
punishment or deprivation. (II)
(2)
Physical abuse includes, but is not limited to, corporal punishment and the use
of restraints as punishment. (II)
(3) Drugs such as tranquilizers may not be
used as chemical restraints to limit or control resident behavior for the
convenience of staff. (II)
(4)
Physicians' orders are required to utilize all types of physical restraints and
shall be renewed at least quarterly. (II) Physical restraints are defined as
the following:
Type I-the equipment used to promote the safety of the
individual but is not applied directly to their person. Examples: divided doors
and totally enclosed cribs.
Type II-the application of a device to the body to promote
safety of the individual. Examples: vest devices, soft-tie devices, hand socks,
geriatric chairs.
Type III-the application of a device to any part of the body
which will inhibit the movement of that part of the body only. Examples: wrist,
ankle or leg restraints and waist straps.
(5) Physical restraints are not to be used to
limit resident mobility for the convenience of staff and must comply with life
safety requirements. If a resident's behavior is such that it may result in
injury to the resident or others and any form of physical restraint is
utilized, it should be in conjunction with a treatment procedure(s) designed to
modify the behavioral problems for which the resident is restrained, or as a
last resort, after failure of attempted therapy. (I, II)
(6) Each time a Type II or III restraint is
used documentation on the nurse's progress record shall be made which includes
type of restraint and reasons for the restraint and length of time resident was
restrained. The documentation of the use of Type III restraint shall also
include the time of position change. (II)
(7) Each facility shall implement written
policies and procedures governing the use of restraints which clearly delineate
at least the following:
a. Physicians' orders
shall indicate the specific reasons for the use of restraints. (II)
b. Their use is temporary and the resident
will not be restrained for an indefinite amount of time. (I, II)
c. A qualified nurse shall make the decision
for the use of a Type II or Type III restraint for which there shall be a
physician's order. (II)
d. A
resident placed in a Type II or III restraint shall be checked at least every
30 minutes by appropriately trained staff. No form of restraint shall be used
or applied in such a manner as to cause injury or the potential for injury and
provide a minimum of discomfort to resident restrained. (I, II)
e. Reorders are issued only after the
attending physician reviews the resident's condition. (II)
f. Their use is not employed as punishment,
for the convenience of the staff, or as a substitute for supervision or
program. (I, II)
g. The opportunity
for motion and exercise shall be provided for a period of not less than ten
minutes during each two hours in which Type II and Type III restraints are
employed, except when resident is sleeping. However, when resident awakens,
this shall be provided. This shall be documented each time. A check sheet may
serve this purpose. (I, II)
h.
Locked restraints or leather restraints shall not be permitted except in
life-threatening situations. Straight jackets and secluding residents behind
locked doors shall not be employed. (I, II)
i. Nursing assessment of the resident's need
for continued application of a Type III restraint shall be made every 12 hours
and documented on the nurse's progress record. Documentation shall include the
type of restraint, reason for the restraint and the circumstances. Nursing
assessment of the resident's need for continued application of either a Type I
or Type II restraint and nursing evaluation of the resident's physical and
mental condition shall be made every 30 days and documented on the nurse's
progress record. (II)
j. Divided
doors shall be of the type that when the upper half is closed the lower section
shall close. (II)
k. Methods of
restraint shall permit rapid removal of the resident in the event of fire or
other emergency. (I, II)
l. The
facility shall provide orientation and ongoing education programs in the proper
use of restraints.
(8) In
the case of an intellectually disabled individual who participates in a
behavior modification program involving use of restraints or aversive stimuli,
the program shall be conducted only with the informed consent of the
individual's parent or responsible party. Where restraints are employed, an
individualized program shall be developed by the interdisciplinary team with
specific methodologies for monitoring its progress. (II)
a. The resident's responsible party shall
receive a written account of the proposed plan of the use of restraints or
aversive stimuli and have an opportunity to discuss the proposal with a
representative(s) of the treatment team. (II)
b. The responsible party must consent in
writing prior to the use of the procedure. Consent may also be withdrawn in
writing. (II)
(9)
Allegations of dependent adult abuse. Allegations of dependent adult abuse
shall be reported and investigated pursuant to Iowa Code chapter 235E and
481-Chapter 52. (I, II, III)
(10)
and
(11) Rescinded IAB 12/11/13, effective 1/15/14.
This rule is intended to implement Iowa Code sections
135C.14,
235B.3(1), and
235B.3(11).