California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 3 - Skilled Nursing Facilities › Article 3 - Required Services › Section 72319 - Nursing Service-Restraints and Postural Supports

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Written policies and procedures
				  concerning the use of restraints and postural supports shall be
				  followed.
(b) Restraints shall only
				  be used with a written order of a licensed healthcare practitioner acting
				  within the scope of his or her professional licensure. The order must specify
				  the duration and circumstances under which the restraints are to be used.
				  Orders must be specific to individual patients. In accordance with Section
				  72317, there shall be no standing
				  orders and in accordance with Section
				  72319(i)(2)(A),
				  there shall be no P.R.N. orders for physical restraints.
(c) The only acceptable forms of physical
				  restraints shall be cloth vests, soft ties, soft cloth mittens, seat belts and
				  trays with spring release devices. Soft ties means soft cloth which does not
				  cause abrasion and which does not restrict blood circulation.
(d) Restraints of any type shall not be used
				  as punishment, as a substitute for more effective medical and nursing care, or
				  for the convenience of staff.
(e)
				  No restraints with locking devices shall be used or available for use in a
				  skilled nursing facility.
(f)
				  Seclusion, which is defined as the placement of a patient alone in a room,
				  shall not be employed.
(g)
				  Restraints shall be used in such a way as not to cause physical injury to the
				  patient and to insure the least possible discomfort to the patient.
(h) Physical restraints shall be applied in
				  such a manner that they can be speedily removed in case of fire or other
				  emergency.
(i) The requirements for
				  the use of physical restraints are:
(1)
				  Treatment restraints may be used for the protection of the patient during
				  treatment and diagnostic procedures such as, but not limited to, intravenous
				  therapy or catheterization procedures. Treatment restraints shall be applied
				  for no longer than the time required to complete the treatment.
(2) Physical restraints for behavior control
				  shall only be used on the signed order of a physician, or unless the provisions
				  of section
				  1180.4(e)
				  of the Health and Safety Code apply to the patient, a psychologist, or other
				  person lawfully authorized to prescribe care, except in an emergency which
				  threatens to bring immediate injury to the patient or others. In such an
				  emergency an order may be received by telephone, and shall be signed within 5
				  days. Full documentation of the episode leading to the use of the physical
				  restraint, the type of the physical restraint used, the length of effectiveness
				  of the restraint time and the name of the individual applying such measures
				  shall be entered in the patient's health record.
(A) Physical restraints for behavioral
				  control shall only be used with a written order designed to lead to a less
				  restrictive way of managing, and ultimately to the elimination of, the behavior
				  for which the restraint is applied. There shall be no PRN orders for behavioral
				  restraints.
(B) Each patient care
				  plan which includes the use of physical restraint for behavior control shall
				  specify the behavior to be eliminated, the method to be used and the time limit
				  for the use of the method.
(C)
				  Patients shall be restrained only in an area that is under supervision of staff
				  and shall be afforded protection from other patients who may be in the
				  area.