Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 967 - Client Care of Individuals Receiving Services at State Supported Living Centers › Subchapter B - Use of Restraints in State Supported Living Centers › Section 967.27 - General Provisions

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Expectations.
(1) A facility must implement
				  and operationalize statewide policy addressing the use of restraint.
(2) At least one person trained as a
				  restraint monitor must be on duty at all times to respond to the initiation of
				  restraint procedures in a behavioral crisis, immediately if possible but in no
				  case in more than 15 minutes. If data suggests a high number of incidents of
				  restraint, additional restraint monitors may be required.
(3) If an individual is in restraint at the
				  time of shift change, staff must communicate and coordinate between shifts to
				  provide continuity of care.
(4) A
				  licensed nurse must assess, for injuries and other negative health effects, an
				  individual who has been restrained; determine if the individual's vital signs
				  are stable; and document the individual's mental status as soon as possible but
				  within 30 minutes after the initiation of restraint. Staff must continuously
				  monitor the individual until the licensed nurse arrives.
(5) A mechanical or physical restraint
				  administered to an individual must:
(A) be
				  the least restrictive restraint effective to prevent imminent physical harm in
				  a behavioral crisis, or to safely and effectively implement a medical or dental
				  procedure, or to prevent or mitigate the documented danger of self-injurious
				  behavior;
(B) be used for the
				  shortest period of time necessary to prevent imminent physical injury, to
				  safely and effectively implement a medical or dental procedure, or to prevent
				  or mitigate the documented danger of self-injurious behavior;
(C) end immediately once the imminent risk of
				  physical injury abates;
(D) be
				  applied with the minimum amount of force or pressure necessary to prevent harm
				  to the individual and others; and
(E) be used in the safest, least restrictive,
				  most humane, and most respectful manner possible.
(6) Staff must attempt to provide an
				  environment that safeguards the individual's personal dignity, privacy, and
				  well-being while ensuring safety.
(7) Staff must provide continuous one-to-one
				  supervision to individuals while in restraint. Individuals receiving medical
				  restraints must receive supervision as ordered by the PCP or dentist in
				  accordance with facility procedures. The director may approve an alternate
				  level of supervision based on the IDT's clinical justification and
				  recommendation.
(8) Staff must
				  respond appropriately to signs or symptoms of restraint-related injuries or
				  distress, including an immediate release from restraint and checks by medical
				  staff.
(9) If an emergency
				  evacuation or an evacuation drill occurs while an individual is in restraint,
				  staff must respond as described in the facility's policies and procedures to
				  ensure the individual's safety.
(10) Staff must allow an individual who has
				  been released from restraint time to recover and return to regular activities,
				  including the opportunity to relax and exercise restrained limbs, to drink
				  fluids, to toilet, to complete a snack or meal, and to receive prescribed
				  medications.
(11) Staff must take
				  all necessary steps to avoid causing undue physical discomfort, harm, or pain
				  to the individual while initiating and implementing restraint.
(12) A facility must obtain legally adequate
				  consent for a crisis intervention plan, medical restraint plan, or protective
				  mechanical restraint plan for self-injurious behavior. A plan must be reviewed
				  by the Behavior Support Committee and the facility director and approved by the
				  Human Rights Committee before implementation.
(13) An authorization to use or extend
				  physical restraints in response to a behavioral crisis may be in effect no
				  longer than 12 consecutive hours.