Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part III - Mental Health Services › Chapter 3 - Client Services › Section III-311 - Restraint and Seclusion

Current through Register Vol. 50, No. 6, June 20, 2024
It is the policy of the Office of Mental Health (OMH) that
				  restraint and seclusion shall only be used to prevent a patient from injuring
				  self or others, or to prevent serious disruption of the therapeutic
				  environment. These may not be used as punishment, discipline or convenience to
				  staff.
A. Process
1. Restraint or seclusion shall only be used
				when verbal intervention or less restrictive measures fail. Use of restraint or
				seclusion shall require documentation in the patient's record of the clinical
				justification for such use as well as the inadequacy of the less restrictive
				intervention techniques.
2. A
				written order from a physician is required for any use of restraint or
				seclusion.
3. In a non-emergency
				situation, the physician shall conduct a clinical assessment of the patient
				before writing the order for use of restraint or seclusion.
4. In an emergency, nursing personnel who
				have been trained in management of disturbed behavior may utilize restraint or
				seclusion. Nursing personnel shall then immediately notify the nursing
				supervisor who will observe and assess the patient. The nursing supervisor will
				then notify the physician and obtain an order. The physician will, as soon as
				possible, and, in no instance more than one hour after initiation, conduct a
				clinical assessment of the patient and give a written order.
5. Written orders for the use of restraint or
				seclusion shall be time limited and preferably not more than four hours in
				duration. In no instance shall it exceed 12 hours without a new order. If
				restraint or seclusion is utilized for longer than 24 hours, written approval
				of the head of the professional staff shall be required.
6. Staff who implement written orders for
				restraint or seclusion shall have documented training in the proper use of the
				procedure for which the order was written.
7. The registered nurse shall assign a
				responsible person for continuous monitoring and care of the patient. A patient
				in restraint or seclusion shall be evaluated every 15 minutes, especially in
				regard to regular meals, bathing, and use of the toilet, and appropriate
				documentation shall be entered in the patient's record. Blood pressure, pulse,
				and respiration shall be taken and recorded at least once per shift. If the
				responsible person is unable to obtain said vital signs, the reason(s) shall be
				documented.
8. Patients are to be
				taken out of restraint or seclusion as soon as it is determined that the
				reasons for this no longer exists, i.e., patient is in control and no longer
				dangerous to self or others or severely disruptive to the therapeutic
				environment.
9. PRN (as needed)
				orders shall not be used to authorize the use of restraint or seclusion. Locked
				door seclusion is not to be used with any Gary W. clients. All uses of
				restraint or seclusion (summarizing types used, duration, and reasons) shall be
				reported daily to the head of the professional staff who shall review and
				investigate any unusual or possibly unwarranted patterns of utilization. A copy
				of this report shall also be sent to the superintendent.