Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 110 - REGULATIONS GOVERNING THE LICENSING AND FUNCTIONING OF SKILLED NURSING FACILITIES AND NURSING FACILITIES › Section 144-110-11 - Physical/Chemical Restraints

Current through 2024-29, July 17, 2024
11.A.
Physical Restraints
The resident has the right to be free from any physical
				  restraints imposed for purposes of discipline or convenience, and not required
				  to treat the resident's medical symptoms.
"Physical Restraints"
are defined as any manual
				  method or physical or mechanical device, material or equipment attached or
				  adjacent to the resident's body that the individual cannot remove easily which
				  restricts freedom of movement or normal access to one's body.
"Discipline"
is any action taken by the
				  facility for the purpose of punishing or penalizing residents.
"Convenience"
is any action taken by the
				  facility to control resident behavior or maintain residents with a lesser
				  amount of effort by the facility and not in the residents' best
				  interest.
11.A.1. All restraints must
				be ordered by a physician. PRN orders for restraints are prohibited.
11.A.2. Documented evidence of less
				restrictive measures to promote greater functional independence must be present
				in the medical record if restraints are used. The care plan must address the
				medical reason for which the restraints are used. The care plan must also
				contain a succession of approaches to be utilized before restraints are
				applied. Consultation with appropriate health professionals regarding the use
				of less restrictive approaches must be obtained when appropriate. Locked
				restraints are prohibited in any case.
a.
				Geriatric and other chairs from which the resident cannot arise without
				assistance and which impede movement are considered a physical
				restraint.
b. Bedrails are
				considered restraints when they are a barrier to the resident for getting out
				of bed.
11.A.3. If a
				trial of less restrictive measures is unsuccessful, and the facility decides
				that a physical restraint would enable and promote greater functional
				independence, then the restraining device may be used only for specific
				time-limited periods.
11.A.4. The
				continued use of restraints must be evaluated as needed, but at least
				quarterly.
11.A.5. There must be
				documented evidence that the resident, family, or legal guardian is aware of
				and agrees with this treatment.
11.A.6. All resident care staff shall be
				trained in the proper application and use of restraints.
11.A.7. Restraints may not be used to permit
				staff to administer treatment to which the resident has not
				consented.
11.A.8. No resident may
				be in a restraint without nursing staff on duty at all times in that section of
				the facility;
11.A.9. Restraints
				are released for at least fifteen (15) minutes every two (2) hours and exercise
				provided. A written record is kept of the times of restraint and
				release.
11.A.10. Every resident in
				restraint is offered toilet privileges at least every two (2) hours or when
				request is made.
11.A.11. When the
				resident is in bed, the restraint must be properly applied to allow the
				resident to turn in bed. It is not necessary to release a restraint during the
				resident's normal sleeping hours, but the restraint must be checked at least
				every two (2) hours. A written record must be maintained of restraint
				checks.
11.A.12. Leather cuff and
				any crotch restraints shall not be used. Four-point restraints are
				prohibited.
11.A.13. Residents
				shall not be confined in a locked room; dutch doors are permissible, provided
				the top section is opened.