Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 58 - Nursing Facilities › Rule 481-58.43 - Resident Abuse Prohibited

Current through Register Vol. 47, No. 3, July 24, 2024
Each resident shall receive kind and considerate care at all
				  times and shall be free from mental, physical, sexual, and verbal abuse,
				  exploitation, neglect, and physical injury. Each resident shall be free from
				  chemical and physical restraints except as follows: when authorized in writing
				  by a physician for a specified period of time; when necessary in an emergency
				  to protect the resident from injury to the resident or to others, in which case
				  restraints may be authorized by designated professional personnel who promptly
				  report the action taken to the physician; and in the case of an intellectually
				  disabled individual when ordered in writing by a physician and authorized by a
				  designated qualified intellectual disabilities professional for use during
				  behavior modification sessions. Mechanical supports used in normative
				  situations to achieve proper body position and balance shall not be considered
				  to be a restraint. (II)
(1) Mental
				abuse includes, but is not limited to, humiliation, harassment, and threats of
				punishment or deprivation. (II)
(2)
				Physical abuse includes, but is not limited to, corporal punishment and the use
				of restraints as punishment. (II)
(3) Drugs such as tranquilizers may not be
				used as chemical restraints to limit or control resident behavior for the
				convenience of staff. (II)
(4)
				Physicians' orders are required to utilize all types of physical restraints and
				shall be renewed at least quarterly. (II) Physical restraints are defined as
				the following:
Type I-the equipment used to promote the safety of the
				  individual but is not applied directly to their person. Examples: divided doors
				  and totally enclosed cribs.
Type II-the application of a device to the body to promote
				  safety of the individual. Examples: vest devices, soft-tie devices, hand socks,
				  geriatric chairs.
Type III-the application of a device to any part of the body
				  which will inhibit the movement of that part of the body only. Examples: wrist,
				  ankle or leg restraints and waist straps.
(5) Physical restraints are not to be used to
				limit resident mobility for the convenience of staff and must comply with life
				safety requirements. If a resident's behavior is such that it may result in
				injury to the resident or others and any form of physical restraint is
				utilized, it should be in conjunction with a treatment procedure(s) designed to
				modify the behavioral problems for which the resident is restrained, or as a
				last resort, after failure of attempted therapy. (I, II)
(6) Each time a Type II or III restraint is
				used documentation on the nurse's progress record shall be made which includes
				type of restraint and reasons for the restraint and length of time resident was
				restrained. The documentation of the use of Type III restraint shall also
				include the time of position change. (II)
(7) Each facility shall implement written
				policies and procedures governing the use of restraints which clearly delineate
				at least the following:
a. Physicians' orders
				shall indicate the specific reasons for the use of restraints. (II)
b. Their use is temporary and the resident
				will not be restrained for an indefinite amount of time. (I, II)
c. A qualified nurse shall make the decision
				for the use of a Type II or Type III restraint for which there shall be a
				physician's order. (II)
d. A
				resident placed in a Type II or III restraint shall be checked at least every
				30 minutes by appropriately trained staff. No form of restraint shall be used
				or applied in such a manner as to cause injury or the potential for injury and
				provide a minimum of discomfort to resident restrained. (I, II)
e. Reorders are issued only after the
				attending physician reviews the resident's condition. (II)
f. Their use is not employed as punishment,
				for the convenience of the staff, or as a substitute for supervision or
				program. (I, II)
g. The opportunity
				for motion and exercise shall be provided for a period of not less than ten
				minutes during each two hours in which Type II and Type III restraints are
				employed, except when resident is sleeping. However, when resident awakens,
				this shall be provided. This shall be documented each time. A check sheet may
				serve this purpose. (I, II)
h.
				Locked restraints or leather restraints shall not be permitted except in
				life-threatening situations. Straight jackets and secluding residents behind
				locked doors shall not be employed. (I, II)
i. Nursing assessment of the resident's need
				for continued application of a Type III restraint shall be made every 12 hours
				and documented on the nurse's progress record. Documentation shall include the
				type of restraint, reason for the restraint and the circumstances. Nursing
				assessment of the resident's need for continued application of either a Type I
				or Type II restraint and nursing evaluation of the resident's physical and
				mental condition shall be made every 30 days and documented on the nurse's
				progress record. (II)
j. Divided
				doors shall be of the type that when the upper half is closed the lower section
				shall close. (II)
k. Methods of
				restraint shall permit rapid removal of the resident in the event of fire or
				other emergency. (I, II)
l. The
				facility shall provide orientation and ongoing education programs in the proper
				use of restraints.