Sec. 10.21.12.09. Limitations on Restraint and Continuous Restraint

A. Staff may not initiate "standing" or "as needed" orders for restraint.

B. A physician may write an order for restraint for a period of up to, but not more than, 24 hours.

C. If a patient in restraint requires continuous restraint for over a 24-hour period, a physician shall:

(1) Conduct a face-to-face evaluation of the patient to determine whether continuous restraint is appropriate;

(2) Document the evaluation in the patient's medical record; and

(3) If the patient is restrained under the provisions of §§D and E of this regulation, carry out the requirements of §C(1) and (2) of this regulation every 24 hours throughout the period that the patient continues in restraint.

D. If restraint is required for a period greater than a continuous 48 hours, the physician may continue restraint only:

(1) In conjunction with the requirements outlined in this chapter;

(2) If the treating physician's documented clinical opinion is that the patient, if released from restraint, would continue to present a danger to self or others or would present a serious disruption to the therapeutic environment; and

(3) With the authorization of the clinical director or the clinical director's physician designee, neither of whom may be the treating physician.

E. Upon a request from a patient's treating physician, the clinical director or the clinical director's designee identified in §D(3) of this regulation, following a face-to-face evaluation of the patient who is restrained, may authorize continued restraint:

(1) For category I restraints, for additional periods of not more than 48 hours each over the initial 48-hour period that a patient is restrained under the provisions of §C of this regulation; and

(2) For category II restraints:

(a) For an initial period of not more than 7 days over the initial 48-hour period that a patient is restrained under the provisions of §C of this regulation; and

(b) For additional periods of not more than 7 days each over the 7-day period of restraint authorized under §E(2)(a) of this regulation, if the patient's treatment team:

(i) Recommends continued restraint and documents the recommendation in the patient's medical record; and

(ii) Incorporates into the treatment plan and any subsequent revisions to the plan the proposed strategies to accomplish discontinuance of the restraint.

F. Each time that restraint is authorized under the provisions of §E of this regulation, the clinical director or the clinical director's designee identified in §D(3) of this regulation shall countersign the physician's order in the patient's medical record for continued restraint.

G. Treatment Team Involvement.

(1) Minimally, at regularly scheduled meetings, the patient's treatment team shall examine the use of restraint for that patient.

(2) Within 7 working days from the initiation of continuous restraint, regardless of whether the patient remains in restraint, the treatment team shall:

(a) When applicable, review the appropriateness of the continued use of restraint;

(b) Establish and implement a plan calculated to eliminate the need for further restraint; and

(c) Identify a team member who shall explain to the patient the potential risks and benefits of continuous restraint.