North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 28 - MENTAL HEALTH, STATE OPERATED FACILITIES AND SERVICES › Subchapter D - TREATMENT OR HABILITATION RIGHTS › Section .0200 - PROTECTIONS REGARDING CERTAIN PROCEDURES › Section 28D .0206 - PROCEDURES: SECLUSION, PHYSICAL RESTRAINTS, OR ISOLATION TIME OUT

Current through Register Vol. 39, No. 2, July 15, 2024
(a) This Rule delineates the procedures to be
				  followed for use of seclusion, physical restraint or isolation time-out in
				  addition to the procedures specified in Rule .0203 of this Section.
(b) This Rule governs the use of physical or
				  behavioral interventions which are used to terminate a behavior or action in
				  which a client is in imminent danger of injury to self or other persons or when
				  property damage is occurring that poses imminent risk of danger, of injury or
				  harm to self or others, or which are used as a measure of therapeutic
				  treatment. Such interventions include seclusion, physical restraint and
				  isolation time-out.
(c) If
				  determined to be acceptable for use within the state facility, the state
				  facility director shall establish written policies and procedures that govern
				  the use of seclusion, physical restraint or isolation time-out which shall
				  include the following:
(1) techniques for
				  seclusion, physical restraint or isolation time-out;
(2) provision for required debriefing for
				  emergency use of seclusion, physical restraint or isolation time-out;
(3) provision, to both new clinical and
				  habilitation staff as part of in-service training, and as a condition of
				  continued employment, for those authorized to use or apply intrusive
				  interventions which shall include, but not be limited to:
(A) competency-based training and periodic
				  reviews on the use of seclusion, physical restraint or isolation time-out;
				  and
(B) skills for less intrusive
				  interventions specified in Rules .0203 and .0204 of this Section;
(4) process for identifying,
				  training and assessing the competence of state facility employees who are
				  authorized to use such interventions;
(5) provisions that a responsible
				  professional shall:
(A) meet with the client
				  and review the use of the intervention as soon as possible but at least within
				  one hour after the initiation of its use;
(B) verify the inadequacy of positive
				  alternatives and less restrictive intervention techniques;
(C) document in the client record evidence of
				  approval or disapproval of continued use; and
(D) inspect to ensure that any devices to be
				  used are in good repair and free of tears and protrusions;
(6) procedures for documenting the
				  intervention which occurred to include, but not be limited to:
(A) consideration that was given to the
				  physical and psychological well-being of the client prior to the use of the
				  restrictive intervention;
(B) the
				  rationale for the use of the intervention which addresses attempts at and
				  inadequacy of positive alternatives and less restrictive intervention
				  techniques; this shall contain a description of the specific behaviors
				  justifying the use of seclusion, physical restraint or isolation
				  time-out;
(C) notation of the
				  frequency, intensity and duration of the behavior and any precipitating
				  circumstances contributing to the onset of the behavior;
(D) description of the intervention and the
				  date, time and duration of its use;
(E) estimated amount of additional time
				  needed in seclusion, physical restraint or isolation time-out;
(F) signature and title of the state facility
				  employee responsible for the use of the intervention;
(G) the time the responsible professional met
				  with the client; and
(H)
				  description of the debriefing and planning with the client and the legally
				  responsible person, if applicable, as specified in Subparagraph (c)(2) of this
				  Rule, or Subpart (b)(6)(A)(xi) of Rule .0203 of this Section, to eliminate or
				  reduce the probability of the future use of restrictive interventions;
				  and
(7) procedures for
				  the notification of others to include:
(A)
				  those to be notified as soon as possible but no more than one working day after
				  the behavior has been controlled to include:
(i) the treatment/habilitation team, or its
				  designee, after each use of the intervention;
(ii) a designee of the State Facility
				  Director; and
(iii) the internal
				  client advocate, in accordance with the provisions of
				  G.S.
				  122C-53(g); and
(B) immediate notification of the
				  legally responsible person of a minor client or an incompetent adult client
				  unless she/he has requested not to be notified.