Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 16.2 - HEALTH FACILITIES; LICENSING AND OPERATIONAL STANDARDS › Rule 3.1 - Comprehensive Care Facilities › Section 3.1-26 - Resident behavior and facility practices

Current through July 10, 2024
Authority: IC
				  16-28-1-7
Affected: IC
				  16-28-5-1
Sec. 26.
(a) Less
				restrictive measures must have been tried by the interdisciplinary team and
				shown to be ineffective before restraints are applied.
(b) Restraint or seclusion shall be employed
				only by order of a physician, and the type of restraint or seclusion shall be
				specified in the order.
(c) Per
				required need (PRN) restraint or seclusion shall only be employed upon the
				authorization of a licensed nurse. All contacts with a nurse or physician not
				on the premises for authorization to administer PRN restraints shall be
				documented in the nursing notes indicating the time and date of the
				contact.
(d) The facility policy
				manual shall designate who is authorized to apply restraints. The facility
				shall have written procedures in which the persons authorized to apply
				restraints have been properly trained.
(e) In emergencies when immediate physical
				restraint or seclusion is needed for the protection of the resident or others,
				restraint or seclusion may be authorized by a licensed nurse for a period not
				to exceed twelve (12) hours. A physician's order to continue restraint or
				seclusion must be obtained in order to continue the restraint beyond the twelve
				(12) hour period.
(f) A record of
				physical restraint and seclusion of a resident shall be kept in accordance with
				this rule.
(g) Each resident under
				restraint and seclusion shall be visited by a member of the nursing staff at
				least once every hour and more frequently if the resident's condition
				requires.
(h) Each physically
				restrained or secluded individual shall be temporarily released from restraint
				or seclusion at least every two (2) hours or more often if necessary except
				when the resident is asleep. When the resident in restraint is temporarily
				released, the resident shall be assisted to ambulate, toileted, or changed in
				position as the resident's physical condition permits.
(i) A resident shall not be placed alone in a
				room with a full, solid locked door.
(j) Key lock restraints shall not be used or
				available in the facility.
(k)
				Chemical restraint shall be authorized in writing by a physician.
(l) An order for chemical restraints shall
				specify the dosage and the interval of and reasons for the use of chemical
				restraint.
(m) Administration of
				chemical restraints shall be documented in accordance with this rule.
(n) Restraints and seclusion shall be used in
				such a way as not to cause physical injury to the resident.
(o) Restraints of any type or seclusion shall
				only be used for the protection and safety of residents or others as required
				by medical symptoms that warrant the restraint, or safety issues that warrant
				the seclusion, and shall not be used as a punishment. Restraints and seclusion
				shall be used in such a way as to minimize discomfort to the
				resident.
(p) Restraints or
				seclusion shall be applied in a manner that permits rapid removal in case of
				fire or other emergency.
(q) The
				resident's legal representative shall be notified of the need for restraint or
				seclusion at the time of the physician's initial order or within twenty-four
				(24) hours after emergency restraint or seclusion is applied. Such notification
				shall be documented in the nursing notes. After the physician's order for
				restraint or seclusion is initially written, the legal representative may
				request in writing not to be notified.
(r) The least restrictive restraint must be
				used. The continued use of the restraint or seclusion must be reviewed at each
				care plan conference. Least or lesser restrictive measures must be considered
				at each meeting.
(s) The use of
				restraints must be reviewed by the interdisciplinary team within one (1) month
				after the application of the restraint, and every thirty (30) days for the
				first ninety (90) days of the restraints, and at least quarterly
				thereafter.
(t) For purposes of IC
				16-28-5-1,
				a breach of:
(1) subsection (j) or (n) is an
				offense;
(2) subsection (a), (b),
				(c), (d), (e), (g), (h), (i), (k), (l), (o), (p), or (r) is a deficiency;
				and
(3) subsection (f), (m), (q),
				or (s) is a noncompliance.