Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 65 - Intermediate Care Facilities for Persons With Mental Illness (ICF/PMI) › Rule 481-65.15 - Restraint or Seclusion

Current through Register Vol. 47, No. 3, July 24, 2024
Physician's orders are required to use any kind of mechanical
				  restraints or seclusion. (I, II, III) Restraints are defined as the
				  following:
1. Type I is physical
				restraint which uses equipment to promote the safety of the individual. It is
				not applied directly to a person. Examples: divided doors and side
				rails.
2. Type II is mechanical
				restraint applied to someone's body. A device is applied to the body to promote
				safety of the individual. Examples: vests or soft tie devices, hand socks,
				geriatric chairs.
3. Type III is
				mechanical restraint applied to any part of the body which inhibits only the
				movement of that part of the body. Examples: wrist, ankle or leg restraints and
				waist straps.
(1) Temporary restraint of
				residents shall be used only to prevent injury to the resident or to others.
				(I, II)
(2) Temporary seclusion may
				be used:
a. To prevent injury to the resident
				or to others; (I, II)
b. To prevent
				serious disruption to the treatment program of other residents; (I,
				II)
c. To decrease stimulation
				which contributes to psychotic behavior; (I, II) and
d. When other interventions have failed. (I,
				II)
Restraint and seclusion shall not be used for punishment, for
				  the convenience of staff, or as a substitution for supervision of program.
				  Seclusion shall be used only in a department approved seclusion room. (I,
				  II)
(3)
				Restraints shall be stored in an area easily accessible to staff. (I, II, III)
				Type II and Type III restraints shall be specifically designed, manufactured,
				and customarily used to restrain individuals hospitalized in licensed
				psychiatric hospitals. Metal and plastic handcuffs, rope and makeshift devices
				are prohibited. (I, II)
(4) Under
				no circumstances shall a resident be allowed to participate in the restraint of
				another resident. (I, II)
(5) There
				shall be written policies that address the basic assumption and philosophy that
				govern the use of seclusion and physical and mechanical restraint. These shall:
a. Define the uses of seclusion and
				mechanical restraints; (III)
b.
				Designate staff who may authorize its use; (III)
c. Identify procedures to follow when
				implementing the policy which shall include provisions to ensure privacy and
				safety for restrained residents; (III) and
d. A written plan for treatment following the
				use of restraint or seclusion.
(6) The physician and QMHP shall be notified
				immediately of the resident's need for placement in restraint or seclusion. An
				order for restraint or seclusion identifying the type, purpose and duration of
				use shall be obtained from the physician. If the resident is in seclusion
				longer than four hours, the physician and qualified mental health professional
				shall visit and evaluate the resident before the seclusion order is continued.
				If the resident is in restraint for two hours, the physician shall be called
				before the restraint order can be continued. If the resident is in restraint
				longer than four hours, the physician and QMHP shall visit and evaluate the
				resident before a restraint order is continued. Standing or PRN orders for
				seclusion or restraint are prohibited. (I, II)
(7) If a resident is restrained with Type II
				or Type III restraints for 6 hours or secluded for 12 hours in a 24-hour
				period; or if the resident is secluded or restrained with Type II or Type III
				restraints for any amount of time in three consecutive 24-hour periods, the
				physician and QMHP shall visit the resident and assess the resident's need for
				a higher level of care. If the need for restraint or seclusion continues, the
				resident shall be transferred to an acute level of care. (I, II)
(8) During any period of mechanical restraint
				or seclusion, the facility shall provide for the emotional and physical needs
				of the resident. (I, II)
(9) The
				resident shall be informed of the reason for seclusion and restraint and
				conditions for release. The resident's guardian shall be notified when Type II
				or Type III restraints or seclusion is used. The facility shall also notify the
				resident's family or other significant person if the resident has previously
				signed a form granting consent to do so. (I, II, III)
(10) Each resident's record shall contain all
				information about restraints or seclusion. The administrator shall maintain a
				daily record of seclusion use. This record shall be available for review by the
				department. (II, III)
Documentation of each incident of restraint or seclusion
				  shall include at least:
a. Clinical
				assessment before the resident is secluded or restrained; (I, II)
b. Circumstances that led to seclusion or
				restraint; (I, II)
c. Explanation
				of less restrictive measures used before restraint or seclusion; (I,
				II)
d. Physician's order; (I,
				II)
e. Visual observation of the
				resident every 15 minutes, or more frequently if needed, to monitor general
				well-being including respirations, circulation, positioning and alertness as
				indicated; (I, II)
f. Description
				of the resident's activity at the time of observation to include verbal
				exchange and behavior; (I, II)
g.
				Description of safety procedures taken (removal of dangerous objects, etc.);
				(I, II)
h. Vital signs, including
				blood pressure, pulse and respiration unless contraindicated by resident
				behavior and reasons documented; (I, II)
i. Release of each mechanical restraint and
				exercise and massage every two hours; (I, II, III) / Record of intake of food
				and fluid; (I, II, III)
j. Number of
				hours and minutes in seclusion. (II, III)
k. Use of toilet; (II, III) and
(11) The facility shall educate
				staff on restraint and seclusion theory and techniques. The training shall be
				conducted by people with experience and documented education in the appropriate
				use of restraint and seclusion. (II, III)
a.
				The facility shall keep a record of the training for review by the department
				and shall include attendance. (II, III)
b. Only staff who have documented training in
				restraint and seclusion theory and techniques shall be authorized to assist
				with seclusion or restraint of a resident. (I, II, III)
(12) The facility shall maintain a record of
				the hours and minutes of each type of restraint and seclusion used on a monthly
				basis.