West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-59 - Patient Rights At State-Operated Mental Health facilities › Section 64-59-10 - Seclusion and Restraints

Current through Register Vol. XLI, No. 28, July 12, 2024
10.1.
				General. Patients have the right to freedom from seclusion or mechanical
				restraints unless otherwise clinically indicated and consistent with the
				applicable standard of care as provided herein. Seclusion and restraint shall
				only be used when there is imminent danger that the patient will injure himself
				or herself or others and when all other less restrictive measures have been
				exhausted or no less restrictive measures are reasonably available. Seclusion
				or mechanical restraints that are used solely as a means of coercion,
				discipline, convenience, or retaliation are prohibited.
The use of restraint or seclusion shall only be administered
				  in accordance with the order of a physician or psychiatrist or, in their
				  absence, an advanced nurse practitioner or physician's assistant responsible
				  for the care of the patient. A registered nurse who is trained in crisis
				  intervention may initiate the emergency application of restraint or seclusion
				  prior to obtaining such an order:
Provided,
That the emergency
				  application of restraints or seclusion requires that the registered nurse
				  obtain an order forthwith after the restraint or seclusion has been applied.
				  Under no circumstance may orders for the use of restraint or seclusion ever be
				  written or provided as a standing order or on an as needed basis.
10.2. Seclusion and Restraint.
				Seclusion of any patient or mechanical restraints for any patient, or both, may
				be administered only as expressly permitted by
				42 C.F.R. §
										482.13(e). The use, time
				period for use, and documentation of the use of seclusion or mechanical
				restraints, or both, in the patient's medical record shall be done in
				accordance with 42 C.F.R. § 482 and the State Operations Manual:
Provided,
That seclusion or mechanical restraints for
				developmentally disabled patients are prohibited and only the "time out"
				procedure developed specifically for each such patient in his or treatment plan
				and in accordance with applicable law may be used for a developmentally
				disabled patient.
All personnel at a mental health facility who administer or
				  assists in the administration of seclusion or the use of mechanical restraints
				  shall undergo training as required by
				  42 C.F.R. §
											482.13(f) and shall further
				  complete subsequent periodic training no less frequently than annually
				  regarding the use of seclusion and or mechanical restraints.
10.3. Time. The time spent in seclusion shall
				be the shortest time required for the patient to regain his or her
				self-control.
10.4. Seclusion
				Inappropriate for Suicidal Patients. Seclusion shall not be used for a patient
				who is actively suicidal or for a patient for whom constant observation has
				been ordered. If the physician determines that seclusion is necessary, the need
				for such seclusion shall be documented in the patient's medical record and
				one-on-one observation of the patient shall be required.
10.5. Items Entitled During Seclusion. A
				patient who is placed in seclusion is entitled to clothing, a bed, a mattress,
				bedding, reading matter, stationery, and similar items. Only when it is
				determined that a specific item may be harmful to the patient may the item be
				withheld. The order for seclusion shall specify those items which are to be
				removed and the reasons for their removal.
10.6. Supervision of Seclusion Room. Any room
				used for seclusion shall be in an area that permits constant supervision by
				staff.
10.7. Seclusion Room
				Supervision. The registered nurse in charge of the unit or shift is responsible
				for assuring that the following seclusion room checks, and procedures are
				carried out:
10.7.1. Each patient in seclusion
				shall be checked no less frequently than every five minutes and as required by
				42 C.F.R. §
											482.13. The seclusion room "check sheet"
				shall be updated to assure the presence and safety of the patient in the
				seclusion room;
10.7.2. The patient
				shall have access to fluids and to the toilet hourly. Meals shall be delivered
				at regular meal times. Compliance with these requirements shall be documented
				on the check sheet; and
10.7.3. The
				case manager, when available, or the registered nurse in charge of the unit or
				shift shall talk directly with the secluded patient and assess the need for
				continued seclusion at least once every hour.