Sec. 10.21.13.07. Limitations on Seclusion and Continuous Seclusion

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

B. Excluding requirements outlined in §D of this regulation, each order or subsequent order for seclusion may be written for a period up to, but not more than, 24 hours.

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

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

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

(3) If the patient is secluded under the provisions of §D 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 seclusion.

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

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

(2) If the treating physician's clinical opinion is that the patient, if released from seclusion, 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. Following 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 in seclusion, may authorize continued seclusion:

(1) For an additional 48 hours over the initial 48-hour period that a patient is secluded under the provisions of §C of this regulation; and

(2) For each period of 7 days over the 48-hour period authorized under §E(1) of this regulation.

F. Each time that seclusion 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 seclusion.

G. Treatment Team Involvement.

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

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

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

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

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