Sec. 10.21.13.04. Procedures in the Use of Seclusion

A. A physician who is responsible either for the care of the patient or for assessment of the appropriateness of seclusion or, when the appropriate physician is not readily available to assess the patient, a registered nurse shall conduct a clinical evaluation of the patient to determine:

(1) Whether an emergency situation is present; or

(2) The degree to which the patient presents a serious disruption to the therapeutic environment.

B. Before instituting seclusion, the physician or registered nurse shall assess whether less restrictive alternative approaches are appropriate and, if so, whether and what approaches have been attempted.

C. When a physician, as identified in §A of this regulation, is immediately available, the physician shall be responsible for determining a patient's need for seclusion and make the decision whether to seclude.

D. Authorization in the Absence of a Physician.

(1) When a physician, as identified in §A of this regulation, is not immediately available, a registered nurse shall determine a patient's need for seclusion and may initiate and direct the use of seclusion.

(2) Within 1 hour of the implementation of the seclusion, a physician shall give a written or verbal order for any seclusion initiated by a registered nurse and, at that time, shall make the clinical determination to continue or discontinue the seclusion.