New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 42 - MECHANICAL RESTRAINTS AND SAFEGUARDING EQUIPMENT › Subchapter 3 - APPLICATION AND IMPLEMENTATION › Section 10:42-3.4 - Implementation standards: community programs for persons with developmental disabilities

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				Following approval by the Behavior Policy Review Committee for the use of
				mechanical restraints, the following 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 emergency restraint order shall be immediately signed by the authorizing
				personnel. However, the use of mechanical restraint may be authorized over the
				telephone by the authorizing personnel in accordance with the following:
i. Such approval is strictly temporary and
				the emergency restraint order shall be reviewed and signed by the authorizing
				personnel 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 staff member requesting 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 for utilizing the restraint. Each
				restraint order must be signed and dated by the authorizing
				personnel.
6. Individuals placed in
				highly restrictive forms of mechanical restraints shall be under continual
				observation by staff trained to recognize signs of physical distress.
7. 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.
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, unless otherwise specified in the
				individual's behavior support plan. 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 of use 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. The individual's personal
				hygiene and nutritional needs shall be met while in restraint.
12. An unusual incident report shall be
				completed if the use of the restraint is unauthorized, improperly implemented,
				or causes injury to the individual.
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. 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 (a)13 above to a Division HRC within 15 working
				days.
15. 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.