New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 42 - MECHANICAL RESTRAINTS AND SAFEGUARDING EQUIPMENT › Subchapter 3 - APPLICATION AND IMPLEMENTATION › Section 10:42-3.3 - Implementation standard: developmental centers and private licensed facilities for persons with developmental disabilities licensed pursuant to N.J.A.C. 10:47

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Following approval by the Behavior Policy
				Review Committee, for use of mechanical restraints, the following standards
				shall apply:
1. The IDT shall review the
				client record to identify potential areas of increased risk in the application
				of mechanical restraints for the individual due to medical conditions, mental
				health status, physical functioning, or other personal characteristics. If
				potential areas of increased risk are identified, the IDT shall obtain an
				opinion from a physician that the technique to be employed is not medically
				contraindicated for the individual prior to an initial restraint
				authorization.
2. In an emergency
				situation, the authorizing personnel shall be responsible for authorizing the
				use of a mechanical restraint.
3.
				Whenever possible, the restraint order shall be immediately signed by the
				licensed psychologist or physician. However, the use of mechanical restraint
				may be authorized over the telephone by the licensed psychologist or physician
				in accordance with the following:
i. Such
				approval is strictly temporary and the restraint order shall be reviewed and
				signed by the licensed psychologist or physician as soon as possible but at
				least within 12 hours of its application; and
ii. The specific circumstances necessitating
				approval over the telephone shall be part of the client record and include the
				name of the party requesting or authorizing the restraint.
4. An emergency restraint order shall be
				effective for not more than one hour. If a new order is issued, all
				authorization shall be renewed.
5.
				Emergency restraint orders shall include documentation of the type of
				mechanical restraint authorized, the length of time to be applied, the reason
				for restraint, and any special instruction. Each restraint order must be signed
				and dated by the authorizing personnel.
6. While in mechanical restraint the
				individual shall be checked by a staff member every 15 minutes. The check shall
				document the following:
i. Whether the
				continued use of the restraint is necessary; and
ii. Whether the restraint is applied in
				accordance with principles of good body alignment, a concern for circulation
				and allowance for change of position.
7. The individual shall be released from
				restraint for a period of not less than 10 minutes during each hour of
				restraint. One limb may be released at a time for a 10-minute period if the
				person cannot be completely released.
8. The individual shall be released
				immediately if he or she appears to be in physical distress or the individual's
				behavior no longer presents a risk. In the event the individual cannot be
				released within 10 minutes, efforts to loosen or change the position of the
				restraint must be attempted. Documented attempts to release each limb
				separately for a 10-minute period shall be made.
9. The use of mechanical restraints, such as
				jumpsuits or open-faced helmets does not require 15-minute checks. The
				individual does not have to be removed from the restraint for a 10-minute
				period during each hour since it does not restrict range of motion.
10. The nature, reasons for and notation of
				each staff check shall be recorded in the client record.
11. If a partially enclosed bed is used as a
				safeguarding device, documentation of 15-minute checks shall not be required.
				It is not necessary to remove the individual from a partially enclosed bed for
				10 minutes during each hour of use if it is used for sleeping. If a partially
				enclosed bed is used as a mechanical restraint, 15-minute checks shall be
				required.
12. The service provider
				shall forward a report of the unusual incident to the Regional Assistant
				Director.
13. Whenever a mechanical
				restraint is used pursuant to
				10:42-2.2(a)1, a
				special meeting of the IDT must be held to review current programming and
				alternatives. If the recurrence of the behavior that required the use of the
				restraint may be anticipated, a behavior support plan shall be considered, and
				if appropriate, developed or modified to address the behavior.
14. An unusual incident report shall be
				completed, if the use of the restraint is unauthorized, improperly implemented,
				or causes injury to the individual.
15. When mechanical restraints are used for
				an individual three times in any contiguous six-month period and are not
				included in a behavior support plan, the IDT shall forward the results of their
				review conducted pursuant to
				10:42-3.4(a)13 
				to a Division HRC within 15 working days.
16. A Division HRC shall review the pertinent
				circumstances surrounding the utilization of the emergency mechanical
				restraints reported by the IDT. The results of the Division HRC review shall be
				forwarded to the Assistant Commissioner or designee within 10 days.