Ohio Administrative Code › Title 5122 - Department of Mental Health and Addiction Services › Chapter 5122-2 - Grievances; Death; Psychotropic Medication; Etc › Section 5122-2-17 - Seclusion and restraint use in regional psychiatric hospitals

Current through all regulations passed and filed through July 1, 2024
(A) The provision
			 of a physically and psychologically safe environment is a basic
			  requirement for effective
			 mental health treatment. Treatment environments free of coercive interventions
			 and violence promote positive, trusting relationships and facilitate treatment
			 and recovery.
Seclusion and physical
									 restraint
				 are emergency interventions
				intended to prevent patient and staff injury.
				They are not a form of therapy and may  be traumatizing to a patient. We
				 strive continually to
				 minimize the use of seclusion
				and restraint. We recognize that these emergency interventions are to be used
				only by trained and competent staff and as a last resort in order to eliminate
				dangerous and potentially harmful behaviors and to preserve safety and dignity.
				All patients should be assessed for any past exposure to these emergency
				interventions along with possible alternative interventions based on patient
				preference and experience.
The fundamental goal of inpatient care is to facilitate
				recovery from serious mental illness, especially from acute exacerbation of
				illness that may affect judgment, perception,
									 emotion, and
				behavior. Quality inpatient care includes a physically and
				psychologically safe environment for both patients and staff. The
				 preference of the department is
				for 
									the use
				of positive, supportive and less intrusive measures
				to engage patients in treatment, including
				the use of counseling, positive relationships,
				and  a therapeutic environment that
				facilitates treatment and recovery.
To reduce incidents that may lead to injuries, staff should
				employ a multi-modal approach and an interdisciplinary,
				trauma-informed, proactive intervention perspective.
The
				experience of seclusion and restraint is stressful for both staff and patients,
				requiring debriefing and support for these individuals. The purpose of this
				rule shall be to define and establish uniform procedures governing the safe,
				humane, and appropriate use of seclusion and restraint consistent with this
				philosophy, standards of quality treatment and respect for the rights of
				patients.
(B) The
			 provisions of this rule shall be applicable to all regional psychiatric
			 hospital inpatient settings operated by the department of mental health
			 and addiction services (OhioMHAS).
(C) The following definitions apply to this
			 rule in addition to or in place of those appearing in rule
			 5122-1-01 of the
			 Administrative Code:
(1) "Chief clinical
			 officer (CCO)" means the medical director of a regional psychiatric hospital
			 (RPH) as defined in division (K) of section
			 5122.01 of the Revised Code.
(2)
			 "Clear treatment reasons" means that permitting the patient to participate will
			 present a substantial risk of physical harm to the patient or others or will
			 substantially preclude effective treatment of the patient. If a restriction is
			 imposed for clear treatment reasons, the patient's written treatment plan shall
			 specify the treatment designed to eliminate the restriction at the earliest
			 possible time.
(3) "Direct care
			 personnel" means personnel with special training, competency and experience in
			 assessing and treating persons with mental illness and whose primary
			 responsibility is for such functions.
(4) "Emergency" means an impending or crisis
			 situation which demands immediate action for preservation of life or prevention
			 of serious bodily harm to the person or others as determined by a licensed
			 physician, licensed practitioner, or registered
			 nurse (RN).
(5) "Hospital services security personnel"
			 means special police as defined in section 5119.08 of the
			 Revised Code and security officers of the regional psychiatric hospital.
(6)
									Licensed practitioner" means an individual who is
			 responsible for the care of the patient and authorized to order restraint or
			 seclusion by hospital policy in accordance with state law and specifically
			 refers to advanced practice nurses (APN) and physician
			 assistants.
(7) "Mechanical
			 supports" means items used for the purpose of achieving proper body alignment,
			 position and balance. Mechanical supports shall not be considered restraints
			 under this rule when used in this manner. Examples include
			 orthopedic-prescribed devices, surgical dressings or bandages, protective
			 helmets, or other methods that involve the physical holding of a patient for
			 the purpose of conducting routine physical examinations or tests, or to protect
			 the patient from falling out of bed, or to permit the patient to participate in
			 activities without the risk of physical harm.
(8) "Physical
			 restraint" means any method, or device that immobilizes or reduces the ability
			 of a patient to move his or her arms, legs, body, or head freely. For purposes
			 of this rule, physical restraint refers to:
(a) "Manual restraint" means physically
			 holding an individual to restrict an individual's ability to move his or her
			 legs, arms, head, or body, freely.
(b) "Physical restraint with devices" means
			 any method of restricting a person's freedom of movement, physical activity, or
			 normal use of his or her body, using an appliance or device manufactured for
			 this purpose.
(c) "Prone restraint"
			 means  measures used to limit
			 or control the movement  of an individual's body while the individual is in a
			 face-down position for an extended period of time. Prone restraint includes
			 manual or physical restraint with devices.
(d) "Transitional hold" means a restraint
			 involving a brief physical positioning of an individual face-down for the
			 purpose of quickly and effectively gaining physical control of that individual
			 in order to prevent harm to self and others, 
										and enable the
			 individual to be transported safely.
(9) "PRN order" means a
			 practitioner's written order for a medication, treatment, or procedure which is
			 only carried out when an individual patient manifests a specific clinical
			 condition.
(10) "Quiet time" means
			 a voluntary procedure through which a patient removes him/herself to an
			 unlocked area from a situation which is too stimulating, in an effort to regain
			 self-control.
(11) "Seclusion" means
			 confinement of a patient alone in a room, locked or unlocked, in which that
			 patient is physically prevented from leaving for any period of time.
(12)
			 "Treatment plan" means a written statement of specific, reasonable and
			 measurable goals and objectives for an individual established by the treatment
			 team, in conjunction with the patient, with specific criteria to evaluate
			 progress towards achieving those objectives.
(13) "Treatment team"
			 means a team comprised of the patient, patient's family as defined and
			 authorized by the patient, psychiatrist, licensed
			 practitioner, or physician so privileged by the facility,
			 RN, social worker, and other appropriate personnel
			 (such as activity therapist, CPST worker, interpreter,
			  dietitian, occupational therapist,
			 pharmacist, psychologist, counselors, and others
			 as appropriate) based on patient needs and requests, and standard-setting
			 agency requirements.