New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter A - Medical Facilities-minimum Standards › Article 3 - Residential Care Facilities › Part 415 - Nursing Homes-minimum Standards › Residential Rights and Services › Section 415.4 - Resident behavior and facility practices

Current through Register Vol. 46, No. 28, July 10, 2024
The facility shall provide each resident with
						  considerate and respectful care designed to promote the resident's independence
						  and dignity in the least restrictive environment commensurate with the
						  resident's preference and physical and mental status.
(a) Physical and chemical restraints. The
						facility and all medical, nursing, and other professional staff shall assure
						that:
(1) the resident is free, consistent
						with subdivision (l) of section
						415.12 of this Part, from any
						psychotropic drug administered for purposes of discipline or convenience, and
						not required to treat the resident's medical conditions or symptoms;
						and
(2) physical restraints, 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, are:
(i) used only to protect the health and
						safety of the resident and to assist the resident to attain and maintain
						optimum levels of physical and emotional functioning;
(ii) an integral part of the
						interdisciplinary care plan that is individualized as to the type of restraint,
						release schedules, type of exercise, necessary skin care and ambulation to be
						provided, and is intended to lead to less restrictive treatment to manage the
						problem for which the restraint is applied;
(iii) used only in unusual circumstances and
						only after all reasonable less restrictive alternatives have been considered
						and rejected for reasons related to the resident's well-being which shall be
						documented showing evidence of consultation with appropriate professionals such
						as social workers and physical therapists. Less restrictive measures that would
						not clearly jeopardize the resident's safety shall not be rejected before a
						trial to demonstrate whether a more restrictive restraint would promote greater
						functional independence;
(iv) not
						used for staff convenience, for purposes of discipline or as substitutes for
						direct care, activities and other services;
(v) an enabler of the highest practicable
						physical, mental or psychosocial well-being; and
(vi) implemented only after the resident or
						designated representative, to the extent permitted by State law, agrees to this
						treatment alternative, except in an emergency situation in accordance with
						paragraph (6) of this subdivision. If the resident or designated representative
						withdraws agreement to the treatment after implementation, the usage shall be
						stopped;
(3) when
						physical restraints are used:
(i) they are
						used in accordance with paragraph (2) of this subdivision and are time limited.
						They are used for specified periods of time, properly applied allowing for some
						body movement and not impairing circulation;
(ii) they are monitored closely as specified
						in paragraph (5) of this subdivision; and
(iii) all plans for restraints are reviewed
						at a frequency determined by the resident's condition or more frequently if
						requested by the resident or designated representative. The clinical record
						shall include documentation of periodic reevaluation of the need for the
						restraint and efforts made to substitute other measures.
(4) Policies and procedures regarding the
						ordering and use of physical restraints and the recording, reporting,
						monitoring and review and modification thereof are:
(i) incorporated into the inservice education
						programs of the facility, with changes made in such programs when policies and
						procedures are modified; and
(ii)
						made known to all medical, nursing and other appropriate resident care
						personnel in advance of implementation.
(5) When physical restraints are used the
						resident is:
(i) released as frequently as
						necessary to meet resident care needs, but at least every two hours except when
						asleep in bed, then released as indicated by the type of restraint and by the
						residents' condition;
(ii) provided
						with changes of position, ambulation or exercise at the time of release;
						and
(iii) observed at least as
						frequently as at the time of dressing and undressing for any evidence of
						adverse effects, including but not limited to circulatory problems or skin
						abrasions.
(6) In an
						emergency situation a physical restraint may only be used if it is:
(i) approved by the medical director,
						attending physician or nursing director, or in his or her absence, by a
						registered professional nurse;
(ii)
						used for that specific emergency and for a limited period of time with
						physician consultation regarding the physical measure or safety device obtained
						within 24 hours;
(iii) applied
						under the direction of a licensed nurse who documents in the clinical record
						the circumstances necessitating the physical restraint and the resident's
						response; and
(iv) monitored
						frequently by a licensed nurse until the resident is seen by a
						physician.
(7) There are
						written policies specifying and defining each type of physical restraint that
						is acceptable and available in the facility and the purposes for which each
						shall be used. Locked restraints shall not be considered acceptable.