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Home > Behavioral Health > Behavior Support and Intervention > Standard or Definition

 
 

ARIZONA
Standard or Definition Arizona
Administrative Code: Title 9, Chapter
20, Article 6
Effective October 3, 2001
Restraint Definition “Restraint” means personal restraint, mechanical restraint, or drug used as a restraint.

“Personal restraint” means the application of physical force without the use of any device, for the purpose of restricting the free movement of a client's body

“Mechanical restraint” means any device, article, or garment attached or adjacent to a client's body that the client cannot easily remove and that restricts the client's freedom of movement or normal access to the client's body but does not include devices used for surgical or orthopedic purposes.
Restraint Exclusions Briefly holding, without undue force, a client in order to calm or comfort the client

Holding a client's hand to safely escort the client from one area to another.
Chemical Restraint Definition “Drug used as a restraint” means a medication that:
  1. Is administered to manage a client's behavior in a way that reduces the safety risk to the client or others,
  2. Has the temporary effect of restricting the client's freedom of movement, and
  3. Is not a standard treatment for the client's medical condition or behavioral health issue.
Seclusion Definition “Seclusion” means the involuntary confinement of a client in a room or an area from which the client cannot leave.
Seclusion Exclusions None.
Criteria for Restraint and Seclusion A licensee shall ensure that:
  1. A policy and procedure is developed, implemented, and complied with:
    1. For the use of each type of restraint or seclusion; and
    2. That identifies the qualifications of a staff member to:
      1. Order restraint or seclusion;
      2. Place a client in restraint or seclusion;
      3. Monitor a client in restraint or seclusion; and
      4. Evaluate a client's physical and psychological well being within one hour after being placed in restraint or seclusion and upon being released from restraint or seclusion;
  2. Restraint or seclusion is not used as a means of coercion, discipline, convenience, or retaliation;
  3. An order for restraint or seclusion is not written as a PRN order;
  4. Restraint or seclusion does not result in harm to a client and is only used:
    1. To ensure the safety of the client or another individual during an emergency safety situation;
    2. After other available less restrictive methods to control the client's behavior have been tried and were unsuccessful; and
    3. Until the emergency safety situation has ceased and the client's safety and the safety of others can be ensured, even if the restraint or seclusion order has not expired; and
    4. Restraint and seclusion are not used on a client simultaneously, except in a Level 1 psychiatric hospital where restraint and seclusion may be used simultaneously if the client receives continuous:
      1. Face-to-face monitoring by a staff member; or
      2. Video and audio monitoring by a staff member who is in close proximity to the client.
  5. A licensee shall ensure that restraint or seclusion is performed in a manner that is:
    1. Safe; and
    2. Proportionate and appropriate to the severity of a client's behavior and to the client's:
      1. Chronological and developmental age;
      2. Size;

      3. Gender;
      4. Physical condition;
      5. Medical condition;
      6. Psychiatric condition; and
      7. Personal history, including any history of physical or sexual abuse.
Monitoring Requirements A licensee shall ensure that a client is monitored during a restraint or seclusion as follows:
  1. A staff member monitors the client's physical and psychological well-being and safety during the restraint on a face-to-face basis, except that a Level 1 psychiatric hospital may use video and audio monitoring according to subsection (A)(5)(b), as follows:
    1. At least once every 15 minutes;
    2. If the client has a medical condition that may be adversely impacted by the restraint or seclusion, at least once every five minutes; and
    3. If other clients have access to the client who is restrained or secluded, continuous staff monitoring on a one-to-one basis is provided;
  2. If a client is in a restraint during a mealtime, the client is given the opportunity to eat and drink;
  3. At least once every two hours, the client is given the opportunity to use a toilet; and
  4. If a client is maintained in a mechanical restraint, the restraints are loosened at least once every 15 minutes.
    A room used for seclusion:
    1. Is designated by the licensee as a room used for seclusion;

    2. Is not a client's bedroom or a sleeping area;
    3. Allows staff members full view of the client in all areas of the room;
    4. Is free of hazards, such as unprotected light fixtures or electrical outlets; and
    5. Contains at least 60 square feet of floor space;
  5. If a client is in seclusion during a mealtime, the client is given the opportunity to eat and drink; and
  6. At least once every two hours, a client in seclusion is given the opportunity to use a toilet.
Ordering and Initiation A licensee shall ensure that:

  1. Restraint or seclusion is only ordered by:
    1. A physician providing treatment to the client; or
    2. If a physician providing treatment to the client is not present on the premises or on-call, a medical practitioner;
  2. If the physician or medical practitioner who orders restraint or seclusion is not present, the physician's or medical practitioner's verbal order is obtained by a nurse at the time the restraint or seclusion is initiated;
  3. A physician or medical practitioner who orders restraint or seclusion:
    1. Is available to staff members for consultation, at least by telephone, throughout the period of the restraint or seclusion; and
    2. Orders the least restrictive restraint or seclusion that is likely to resolve the emergency safety situation, based upon consultation with staff members at the agency;
  4. An order for restraint or seclusion includes:
    1. The name of the physician or medical practitioner ordering the restraint or seclusion;
    2. The date and time that the restraint or seclusion was ordered;
    3. The specific restraint or seclusion ordered;
    4. The specific criteria for release from restraint or seclusion without an additional order; and
    5. The maximum duration authorized for the restraint or seclusion;
  5. An order for restraint or seclusion is limited to the duration of the emergency safety situation and does not exceed:
    1. Four hours for a client who is 18 years of age or older;
    2. Two hours for a client who is between the ages of nine and 17; or
    3. One hour for a client who is younger than nine;
  6. A physician or medical practitioner ordering restraint or seclusion signs the order as soon as possible after the date of the order; and
  7. If the medical practitioner ordering the use of restraint or seclusion is not a physician providing treatment to the client, the medical practitioner ordering restraint or seclusion:
    1. Consults with the physician providing treatment as soon as possible and informs that physician of the emergency safety situation that required the client to be restrained or placed in seclusion; and
    2. Provides documentation for the client record of the date and time that the physician providing treatment to the client was consulted.
In-person Assessment A licensee shall ensure that a face-to-face assessment of a client's physical and psychological well-being is performed within one hour after the initiation of restraint or seclusion by a registered nurse with at least one year of full time behavioral health work experience, who is either onsite or on-call at the time that the restraint or seclusion was initiated. (For a Level 1 RTC, a Level 1 sub-acute agency, or a Level 1 specialized transitional agency)
Debriefing A licensee shall ensure that within 24 hours after the use of restraint or seclusion face-to-face debriefings occur or are scheduled to occur within seven days as follows:
  1. Both the client, unless the client declines to participate, and all staff members involved in the restraint or seclusion receive a debriefing, although the client and staff member debriefings do not need to occur at the same time;
  2. A client's debriefing is conducted:
    1. By a behavioral health professional; and
    2. In a language that is understood by the client and, if present, the client's parent, guardian, or custodian;
    3. A debriefing may include the client's parent, guardian, or custodian and other staff members, if directed by the clinical director or the clinical director's designee;
    4. A debriefing provides the client and staff members the opportunity to discuss the
      circumstances that resulted in restraint or seclusion and strategies that could be used by the client, staff members, or other individuals to prevent future use of restraint or seclusion; and
    5. Each debriefing is documented at the agency and includes the:
      1. The date of the debriefing;
      2. The names of the individuals participating in the debriefing;
      3. The precipitating factors that led up to the restraint or seclusion;
      4. Alternative techniques that were used to prevent the use of restraint or seclusion;
      5. The outcome of the restraint or seclusion, including any injuries that may have resulted from the restraint or seclusion; and
      6. If any individual was injured, the circumstances that caused the injury and a plan to prevent future injuries.
Family & Guardian Notification If a client is a minor, the parent, guardian, or custodian of the client is notified, or an attempt is made to notify, as soon as possible and no later than one day after the initiation of restraint or seclusion or as requested by the parent, guardian, or custodian of the client.

The notification must be documented in the client record and include:
  1. The date and time of the notification or attempt, and
  2. The name of the staff member providing the notification.
Notification of Rights and Restraint and Seclusion Policies and Procedures at admission None.
Training Any staff member, including a medical practitioner, who is involved in ordering restraint or seclusion, performing restraint or seclusion, monitoring a client during restraint or seclusion, or evaluating a client after restraint or seclusion:
  1. Before participating in restraint or seclusion, completes education and training:
    1. That includes:
      1. Techniques to identify staff member and client behaviors, events, and environmental factors that may trigger emergency safety situations;
      2. The use of nonphysical intervention skills, such as de-escalation, mediation, conflict resolution, active listening, and verbal and observational methods;
      3. The safe use of restraint and the safe use of seclusion, including the ability to recognize and respond to signs of physical distress in a client who is restrained or secluded; and
      4. Training exercises in which staff members successfully demonstrate in practice the techniques that they have learned for managing emergency safety situations; and
    2. Taught by individuals who have education, training, and experience in preventing and using restraint or seclusion;
  2. Successfully completes CPR training that includes a demonstration of the staff member's ability to perform CPR at least once every 12 months; and
  3. Has documentation in the staff member's personnel file indicating compliance with the training requirements and including:
    1. The date training was completed; and
    2. The name of the individual verifying the staff member's completion of the training.
Documentation A licensee shall ensure that, at least once a month, the clinical director or medical director reviews documentation of each use of restraint or seclusion that has occurred at the agency in the past month as follows:
  1. The clinical director or medical director determines and documents:
    1. Whether staff members are using restraint or seclusion according to the agency's policy and procedure, this Chapter, and applicable federal or state laws and rules;
    2. Actions to be taken by the agency to prevent the use of restraint or seclusion, such as additional staff training or changes to agency policy and procedure;
    3. Whether a client is appropriately placed at the agency; and
    4. Whether the client's treatment plan should be reviewed or revised to ensure that the client's treatment is meeting the client's treatment needs.
Reporting The documentation described above must be submitted to the OBHL within five days after the end of the calendar month and documentation is maintained at the agency that the written report was provided.
Quality Improvement In the documentation process, the licensee is required to document actions to be taken to prevent the use of restraint or seclusion.



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