| All restraints for purposes of behavioral
management, staff convenience, or resident discipline are
prohibited. Seclusion is prohibited. |
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(1) As provided in §92.125(a)(3)
of this chapter (relating to Resident's Bill of Rights and
Provider Bill of Rights), a facility may use physical or
chemical restraints only: |
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(A) if the use is authorized in
writing by a physician and specifies: |
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(i) the circumstances under which a
restraint may be used; and
(ii) the duration for which the restraint may be used; or |
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(B) if the use is necessary in
an emergency to protect the resident or others from injury. |
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(2) A behavioral emergency is a
situation in which severely aggressive, destructive,
violent, or self-injurious behavior exhibited by a resident: |
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(A) poses a substantial risk of
imminent probable death of, or substantial bodily harm to,
the resident or others;
(B) has not abated in response to attempted preventive
de-escalatory or redirection techniques;
(C) could not reasonably have been anticipated; and
(D) is not addressed in the resident's service plan. |
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(3) Except in a behavioral
emergency, a restraint must be administered only by
qualified medical personnel.
(4) A restraint must not be administered under any
circumstance if it: |
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(A) obstructs the resident's
airway, including a procedure that places anything in, on,
or over the resident's mouth or nose;
(B) impairs the resident's breathing by putting pressure on
the resident's torso;
(C) interferes with the resident's ability to communicate;
or
(D) places the resident in a prone or supine position. |
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(5) If a facility uses a
restraint hold in a circumstance described in paragraph (2)
of this subsection, the facility must use an acceptable
restraint hold. |
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(A) An acceptable restraint hold
is a hold in which the individual's limbs are held close to
the body to limit or prevent movement and that does not
violate the provisions of paragraph (4) of this subsection.
(B) After the use of restraint, the facility must: |
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(i) with the resident's consent, make an
appointment with the resident's physician no later than the
end of the first working day after the use of restraint and
document in the resident's record that the appointment was
made; or
(ii) if the resident refuses to see the physician, document
the refusal in the resident's record. |
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(C) As soon as possible but no
later than 24 hours after the use of restraint, the facility
must notify one of the following persons, if there is such a
person, that the resident has been restrained: |
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(i) the resident's legally authorized
representative; or
(ii) an individual actively involved in the resident's care,
unless the release of this information would violate other
law. |
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(D) If, under the Health
Insurance Portability and Accountability Act, the facility
is a "covered entity," as defined in 45 Code of Federal
Regulations (CFR) §160.103, any notification provided under
subparagraph (C)(ii) of this paragraph must be to a person
to whom the facility is allowed to release information under
45 CFR §164.510. |
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(6) In order to
decrease the frequency of the use of restraint, facility
staff must be aware of and adhere to the findings of the
resident assessment required in subsection (c) of this
section for each resident.
(7) A facility may adopt policies that allow less use of
restraint than allowed by the rules of this chapter.
(8) A facility must not discharge or otherwise retaliate
against: |
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(A) an employee, resident, or
other person because the employee, resident, or other person
files a complaint, presents a grievance, or otherwise
provides in good faith information relating to the misuse of
restraint or seclusion at the facility; or
(B) a resident because someone on behalf of the resident
files a complaint, presents a grievance, or otherwise
provides in good faith information relating to the misuse of
restraint or seclusion at the facility. |
