5.10-1
Principles
Use of each Safety Device must be reviewed individually
according to the process set out in this regulation. The purpose of the Safety
Device, the impact its use has upon the person for whom it is prescribed or
recommended, and the degree of intrusiveness the device imposes must be
determined on an individual basis. Safety Devices that impose a greater degree
of intrusiveness upon the person and have a greater impact upon the mobility of
the person or the comfort of the person warrant a higher degree of scrutiny and
oversight. Any Safety Device must impose the least possible restriction
consistent with the purpose of insuring safety. Safety Devices may never be
used as punishment, for staff convenience, or as a substitute for teaching the
person new skills or abilities that would eliminate the underlying risk that
gives rise to the request for the use of the device.
Review of the use of a Safety Device pursuant to this rule
does not require a finding of a Challenging Behavior.
Except as provided in Section 5.10-7, a Safety Device may not
have as its purpose, in whole or in part, the provision of Behavior
Management.
5.10-2
Specific Examples of Devices Usually Considered to be Safety
Devices:
The following is a list of devices or protective garb that
could be considered to be Safety Devices:
A. A one-piece suit to prevent the person
from pulling out an ostomy bag or interfering with similar medically necessary
procedures, equipment, or apparel;
B. A locked cupboard or locked refrigerator
when the locking is implemented for the purpose of keeping a person with
uncontrollable eating impulses from dangerous eating habits. This procedure
must be supported by a medical diagnosis of a related disability, such as pica
or Prader-Willi syndrome;
C. Hand
splints or gloves when used to prevent pica behavior or as a medically
necessary intervention;
D. A seat
belt on a wheelchair when used to prevent the person from falling out of the
wheelchair;
E. A seat belt on a
wheelchair when used to prevent the person from getting out of the wheelchair
because the person has a history of falling or being unsteady;
F. A seat belt on a toilet when used to
prevent the person from getting off the toilet when the person has a history of
falling off the toilet or getting off the toilet and being unsteady;
G. Foot straps on a wheelchair when used to
prevent the person's feet from dragging or getting caught;
H. A diver's belt in a bathtub when used to
prevent the person from floating while being bathed;
I. A chest strap while on the toilet when
used to prevent the person from falling off the toilet;
J. A belt on a chair, including a shower
chair or a Hoyer lift, when used to keep the person from falling or slipping
out of the chair or lift;
K. Any
bed rail that substantially inhibits the person from rising off of or getting
out of the bed when the person has a history of unintentionally
falling;
L. A gait belt for a
person, when used to assist the person with walking or transfers and the person
has a history of unsteadiness or falls;
M. A helmet used solely for safety purposes,
for instance to protect a person who has a history of falling because of
seizures. See also Section 5.10-7;
N. Monitoring devices that do not limit the
Person's movement when used to monitor the movement of a Person due to lack of
environmental awareness or history of unintentional falling. Examples of these
devices include a sound monitor that picks up sounds in the vicinity of the
person and transmits those sounds to staff, a chair alarm, a bed alarm, an
ankle bracelet, a door alarm or light (including infrared light).
Non-exclusivity of the Lists of Devices Above:
The devices listed above are not intended to describe every Safety Device that
might be used or devised. Planning Teams and qualified professionals may
suggest other Safety Devices and those Safety Devices may be utilized if they
meet the definition of a Safety Device under state law and this regulation.
Review Teams may use the lists above as guidance in judging by analogy whether
the purpose and use of any proposed device qualifies the device as a Safety
Device as defined above.
5.10-3
Review Process
A.
Preliminary Requirements Prior to
Review
1. Any use of a Safety Device
must be pursuant to a written recommendation from a physician qualified to
practice in the state of Maine.
2.
Any use of a Safety Device must be approved by the Person's Planning Team, and
that approval must be recorded in a document that is part of the Person's
planning record. Any member of the Planning Team may request review or
involvement by an Advocate.
3. If the person has a guardian, or if the
person is under limited medical guardianship, the guardian must approve the use
of the Safety Device. If the person does not have a guardian, the person must
consent to the use of the Safety Device.
4. When a Person has a Safety Device that may
impact other Persons residing in the home or participating in the program by
restricting their Rights, accommodations must be identified and implemented to
minimize the impact on the other Persons. The Personal Plan of each Person
affected by the use of the Safety Device must indicate how that Person will be
supported to minimize the negative impact of any restriction.
5. When a video monitoring device or video
recording is used and it is highly predictable that another Person will trigger
or appear on the monitoring or recording device, the consent of that Person
must be obtained.
B.
Frequency of Review
Any use of a Safety Device must be reviewed at least once
per year by the Review Team. Any preliminary requirements for review, as set
out in Section 5.10-3(A), must be renewed each year prior to reapproval by the
Review Team. Any member of the Review Team may require that use of a Safety
Device be reviewed more frequently. If review takes place more frequently than
annually, any consent, approval, or recommendation that is a preliminary
requirement for review must be current at the time of the review.
C.
Standard Forms
All initial and renewal requests for permission to use a
Safety Device must be submitted on a standard form made available by the
Department. Each request for permission must be accompanied by the written
recommendation of a physician, and any required consents for the use of the
Safety Device. The request form must clearly identify the Safety Device and
must describe the conditions of use of the device and the anticipated frequency
of its use. The request form must include a place for the Review Team to
indicate approval or disapproval of the Safety Device and must include a
mailing address and fax number to which the approval can be sent.
D.
Requests for Multiple
Safety Devices for the same person
Each request for permission to use a Safety Device must have
its own professional authorization that refers specifically to that Safety
Device. Any consent and Planning Team approval required to use a Safety Device
must refer specifically to the Safety Device for which the consent or approval
is being given. Safety Devices that are normally used in pairs, such as gloves
or foot straps, do not need separate requests.
E.
Review Team Practices For Safety
Devices
The approval of a Safety Device requires both voting members
to vote in favor of the plan or the plan with conditions. The Review Team may
require additional information prior to approval of a Safety Device.
F.
Time for Decision
The Review Team shall make a determination of approval or
disapproval within thirty (30) calendar days of its receipt of the request for
approval and all completed supporting or accompanying documentation necessary
to conduct the review.
G.
Notifications after Review
The person or entity requesting approval to use a Safety
Device is responsible for notifying the Person's Planning Team of the decision
made by the Review Team. The Planning Team may designate a member of the team
to receive this notification.
5.10-4
Use of Safety Related Devices or
Practices that Do Not Need Approval of the Review Team
The following safety related devices or practices are not
uses of Safety devices for the purpose of this rule and therefore are not
subject to the above requirements in these regulations.
A. The routine use of seat belts in a
vehicle;
B. Use of tie downs in a
van to prevent a person in a wheelchair from flipping over;
C. The practice of having vehicle doors
locked while the vehicle is moving, when applied by written agency policy to
all persons transported in a vehicle;
D. A doctor's order that a Person be held
temporarily or that a device such as a strap be used to temporarily restrain a
Person so that a medical procedure (such as the drawing of blood from the
Person) can occur. A written doctor's order for the physical restraint or for
the device is necessary as part of or as an adjunct to the order for the
medical procedure that is being performed.
E. A doctor's order that a Person be held
temporarily or that a device be used temporarily to restrain a Person's
movement due to a change in medical condition in order to feed the person, or
for the routine administration of medication, or for aiding the Person's
performance of activities of daily living skills. Any such order may be applied
only in the circumstances prescribed in the written order by the doctor. Any
such order for a temporary restraint must have the consent of the guardian if
the Person is under guardianship, or the consent of the Person if the Person is
not under guardianship.
F. A
doctor's standing order for the holding of a Person or the use of a device that
restrains a Person's movement in order to feed the Person, or for the routine
administration of medication, or for aiding the Person's performance of
activities of daily living skills. Any such standing doctor's order must be
approved by the Person's Planning Team, and must have the consent of the
guardian if the Person is under guardianship, or the consent of the Person if
the Person is not under guardianship.
G. Use of any device that is a Therapeutic
Device.
5.10-5
Requirements for the Use of a Therapeutic Device
A. Any therapeutic device may only be applied
under the supervision of a medical doctor, occupational therapist, or physical
therapist licensed to practice in the state of Maine. The professional may
delegate responsibility for the day-to-day application of the use or
application of the support to others, as long as any other persons applying the
support have been trained in the proper use of the support and the professional
retains professional responsibility for the application of the
support.
B. The use and design of
any Therapeutic Device must be individualized to the specific need of the
person who is using the support, so as to meet the need and maximize the
comfort of the person.
C. Any
Therapeutic Device must make allowance for the person to change body
position.
D. The impact upon the
person's body alignment and blood circulation must be considered in the use of
any Therapeutic Device.
5.10-6
Distinctions Between Safety
Devices, Devices that are Utilized for Behavioral Management, and Therapeutic
Devices.
When the same device or apparatus meets the definition of a
Therapeutic Device, a device for behavioral management, or a Safety Device the
Person's Planning Team should initially render a classification.
Notwithstanding this initial classification, the Review Team may exercise its
own discretion in classifying any device, intervention, or practice.
5.10-7
Helmets Used to
Prevent or Diminish the Degree of Injury to a Person Engaging in Self Injurious
Behavior
A helmet whose primary purpose is to protect a Person from
self-injurious behavior or to diminish the degree of injury of a person engaged
in self-injurious behavior, or whose purpose is to prevent a person from biting
others, is presumed to be part of a Level 3 Behavior Management Plan for the
first year of its use. The use of the helmet during that year is subject to the
requirements for review under Section 5.10-3. A Review Team may exercise its
discretion to classify the use of a helmet for the purposes enumerated in this
paragraph as a Safety Device if after the expiration of the first year of the
device's use it concludes that the primary purpose of the use of the helmet is
as a Safety Device and that review of the use of the helmet as behavior
intervention is no longer necessary.
5.10-8
Use of Monitoring Devices for
Safety
Monitoring devices must only be considered after less
intrusive techniques have been tried and failed. Motion detectors, sound
monitoring, and video monitoring devices must be supported by a history of a
lack of environmental awareness and/or a related medical diagnosis, such as
Dementia.
Every effort must be made to maintain privacy and
confidentiality in the use of these devices. The plan must include procedures
used to maximize privacy and maintain confidentiality.
