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ALABAMA
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Standard or
Definition
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AL DMH/MR
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Restraint
Definition
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Restraint is the direct application of physical force,
without use of any device, to an individual, without the individual's
permission, to restrict his or her freedom of movement.
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Restraint Exclusions
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Does not include briefly holding without undue
force to calm or comfort or to escort a consumer from one area to another.
Does not apply to:
- use of restraint associated with acute medical care
- Physical redirection or holding against the child's will for 15 minutes or less
- use of restraint through formal behavior management programs for intractable
behavior
- protective equipment such as helmets
- adaptive support such as orthopedic appliances.
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Chemical Restraint
Definition
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None
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Seclusion Definition
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Involuntary confinement of a person in a locked room or
room where egress is blocked.
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Seclusion
Exclusions
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Does not include time out in an unlocked area when egress
is not blocked.
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Criteria for
Restraint and Seclusion
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Restraint and seclusion are safety procedures
of last report and not therapeutic interventions.
Mechanical restraints are prohibited.
Children/adolescents may be placed in
seclusion and physically restrained only in emergency situations when
necessary to: prevent the child/adolescent from physically harming self or
others, when less restrictive treatment interventions have been unsuccessful
or are determined not to be feasible and when authorized by a qualified
individual.
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Monitoring
Requirements
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Continuous in person observation by an
assigned staff person to monitor physical safety.
Every fifteen minutes staff must monitor:
vital signs, nutritional and hydration needs, breathing, circulation, range
of motion in extremities, hygiene and elimination, psychological status, behavioral
criteria for discontinuation of restraint/seclusion, signs of injury.
If individual is in restraint a second person
must observe.
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Ordering and
Initiation
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Seclusion and restraint may be initiated only
by order of a licensed practitioner (LIP) who is primarily responsible for
the individual's care, his/her designee, or other trained staff member.
No longer than one hour after initiation,
there must be a verbal or written order from an LIP.
Orders are limited to 2 hours for children
ages 9 - 17, one hour for children under age 9.
May not be standing (PRN) orders.
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In-person
Assessment
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There must be in person assessment by the time
the initial order for restraint or seclusion expires.
The LIP conducts an in person reevaluation at
least every 4 hours for individuals 9 and older and every two hours for
individuals under age 9.
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Debriefing
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Debriefing occurs within 24 hours and includes the
individual, staff involved and the individual's family as specified in intake
agreement. Debriefing identifies what
led to the incident and what could have been handled differently; ascertains
the individual's physical well-being; counsels the individual involved for
any trauma that may have resulted from the incident; modifies the
individual's treatment plan, when indicated.
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Family &
Guardian Notification
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Family/guardian notification occurs within 24 hours as
specified in take agreement.
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Notification of
Rights and Restraint and Seclusion Policies and Procedures at admission
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The initial assessment obtains information
from the family that could help minimize the use of restraint and seclusion
and informs the family about use and reporting.
The individual/family is informed of the
organization's philosophy on the use of restraint and seclusion to the extent
that such information is not clinically contraindicated.
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Training
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Specific requirements for annual training for staff who
perform restraint and seclusion. All staff are competent in first aid and
CPR. Training Includes all elements
cited above in "monitoring." Additional requirements for staff who
authorize restraint/seclusion include: recognizing how personal factors and
developmental considerations affect reactions to physical contact, use of
behavioral criteria.
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Documentation
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For each episode, consumer record documents: 1)
circumstances that led to use, 2) consideration or failure of non-physical
interventions, 3) rationale for use, 4) notification of family/guardian, 5)
criteria for discontinuation of restraint/seclusion, 6) informing the
individual of criteria, 7) written/verbal order received from an LIP, 8) each
in person evaluation/re-evaluation 9) 15 minute assessments of individual's
status, 10) assistance provided to help individual to meet criteria for
discontinuation, 11) continuous monitoring, 12) debriefing of the individual
with staff 13) any injuries sustained and treatment received.
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Reporting
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The organization must report the use of
restraint and seclusion to DMH/MR in accordance with published reporting
guidelines.
Must report injuries and deaths to external
agencies.
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Quality Improvement
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Documentation noted above is maintained "in a manner
that allows for the collection and analysis of data for performance
improvement activities."
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