Restraint and Seclusion

INTRODUCTION: This discussion will briefly explain the laws, rules and policies regarding restraint and seclusion and consumers' rights during a restraint or seclusion.

OVERVIEW: These multitude of laws, rules and policies, all define the scope and limitation on the use of R&S.

LAWS AND REGULATIONS:

• R&S may only be used in an emergency situation to prevent an individual from hurting themselves or others, they cannot be used as punishment, convenience, coercion or discipline.
• Any staff member using R&S must be trained in the use of R&S.
• An order for the use of R&S may only be given by a trained physician,] or if not available, by a physician or nurse practitioner in a level 1 psychiatric hospital or a medical practitioner in a level 1 subacute facility.
• An order for a R&S cannot last any longer than the emergency situation requires, and in no circumstances longer than 3 hours for an adult, 2 hours for a child 9 to 17, and an hour for children younger than 9.
• There may only be one renewal order, after this, a face-to-face assessment must be conducted for further orders, and an individual cannot be R&S for more than 12 consecutive hours.

• A face-to-face assessment must be done withing one hour of the initiation of the R&S.

• Monitoring must be face-to-face, except a level 1 psychiatric acute hospital may use video or audio monitoring.
• Monitoring must be done one every 15 min., unless the individuals health and safety is at risk, then once every 5 min. and if other consumers have access to the individual, then monitoring must be constant.
• The individual must be alloed to eat and drink during mealtime, and use the bathroom at least once every 2 hours.

• Same as restraint.
• The seclusion room cannot be the individuals room, must allow full sight by staff, be at least 60 sq. ft., free of hazards and have a metal frame bed bolted to the floor.

• For individuals diagnosed with a serious mental illness, the provider must report all uses of R&S to DBHS Office of Human Rights by the 10th of each month.
• For any death or injury resulting from the use of R&S, the provider must report the incident to ADHS Office Of Behavioral Health Licensure within 24 hours, and following with an incident report withing 5 days.
• For any death or injury resulting from the use of R&S, the provider and T/RBHA must report the incident to DBHS Office of Grievance and Appeals to initiate an investigation.

• For a serious occurrence OBHL must report the incident to AHCCCS and the Ariz. Center for Disability Law within 1 day, and a death must be reported to CMS.

• A trained staff member may hold an individual in a safe manner until the emergency situation abates, but no longer than 5 minutes, any longer is a restraint.

• 2 types, quiet time and time out.

• An individual can use quiet time to calm down or prevent getting upset.
• The individual must ask staff permission to use quiet time.
• The staff canont prevent an individual from leaving quiet time or it becomes a seclusion.

• When an individual is disruptive or posing a danger to self or others, staff may ask the individual to go to time out.
• Pursuant to Federal guidelines, physical escorts to time out is not considered a restraint or seclusion.
• A person must be allowed to leave time out ot any time or their own choosing, if not then it is a seclusion.
• If an individual leaves times out before they have calmed down or the emergency situation has dissipated, then the individual may be assessed for the appropriateness of a R&S.
• A person cannot be required to remain in time out any longer than it takes for the individual to calm down and for the emergency situaion to dissipate, or it is a seclusion.
• A seclusion includes situations in which an individual "does not reasonalbley believe he can leave unrestricted."
• If an individual is threatened with retaliation or punishment, like loss of privileges, for leaving time out before a set duration of time has expired, even though the individual has calmed down and the emergency situation no longer exists, then the individual does not reasonably believe they can leave unrestricted, therefore it is a seclusion.

• The use of R&S is a very risky, difficult and demeaning process.
• Because of a history of abuse, deaths and injuries, as we have seen, many agencies have regulatory oversight of the R&S process.
• Thus, a facility should be inventive to do all they can to avoid the use of R&S.