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FLORIDA
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Standard or
Definition
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FAC 62-2
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Restraint
Definition
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“Restraint” means restricting the movement of a person’s limbs, head or
body by the use of mechanical or physical devices for the purpose of
preventing injury to self or others.
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Restraint Exclusions
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None.
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Chemical Restraint
Definition
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A drug used to control behavior or to restrict the client's freedom of
movement and is not a standard treatment for the client’s condition.
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Seclusion
Definition
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“Seclusion” means the isolation and containment of residents who pose
an imminent threat of physical harm to themselves or others.
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Seclusion
Exclusions
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None.
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Criteria for
Restraint and Seclusion
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The use of restraint and seclusion shall require justification in
writing. Restraint and seclusion can only be used in emergency situations to
ensure the client’s physical safety and only when less restrictive
interventions have been determined to be ineffective, specifically
de-escalation techniques. Restraint and seclusion shall not be employed as
punishment or for the convenience of staff and shall be consistent with the
rights of clients.
The use of chemical or mechanical restraints is prohibited unless used
under a physician’s order in a facility certified under Administrative
Chapter 65E-10, F.A.C.
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Monitoring
Requirements
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Staff shall conduct a visual observation of clients who are placed in
restraint or seclusion every 15 minutes. The observation shall be documented
in the restraint and seclusion log book, and shall include the time of the
observation and description of the condition of the client.
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Ordering and
Initiation
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1. Orders for the use
of restraint or seclusion must never be written as a standing order or on an
as needed basis.
2. The treating physician must be consulted with as soon as possible in
those instances where restraint or seclusion was not ordered by the client’s
treating physician.
3. Each written order for restraint or seclusion is limited to 4 hours
for adults, 2 hours for children and adolescents ages 9 to 17, and 1 hour for
children under 9. The original order may only be renewed in accordance with
these time limits for up to a total of 24 hours. After the original order
expires, a physician or qualified professional licensed under Chapters 490 or
491, F.S., must see and assess the patient before issuing a new order.
4. The use of restraint and seclusion must be implemented in the least
restrictive manner possible. In addition, restraint and seclusion must be
applied in accordance with safe and appropriate techniques and ended at the
earliest possible time.
5. Restraint and seclusion may not be used simultaneously unless a
client is continually monitored face-to-face by an assigned staff member, or
continually monitored by staff using both video and audio equipment.
6. The condition of the client who is in restraint or seclusion must
continually be assessed, monitored, and reevaluated.
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In-person
Assessment
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Upon completion of the use of restraint or seclusion, the client shall
receive a nursing physical screen by an R.N. that will include an assessment
of the client’s vital signs, current physical condition, and general body
functions.
The screening shall be documented in the client record. In addition,
counseling shall be provided in accordance with the needs of the client in an
effort to transition the client from restraint or seclusion.
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Debriefing
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None.
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Family &
Guardian Notification
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None.
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Notification of
Rights and Restraint and Seclusion Policies and Procedures at admission
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The facility shall have written policies on discipline, control and
punishment which shall be provided to all children, parent or guardian,
staff, agencies and the department. The policies for discipline and control
shall emphasize positive, instead of punitive, methods.
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Training
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The facility shall have a written plan for the orientation, ongoing
training, and professional development of all staff members.
(2) The facility shall ensure that staff members working directly with
children receive at least 40 hours of training activities during each full
year of employment. Activities related to supervision of the staff member’s
routine tasks shall not be considered training activities for the purposes of
this requirement.
(3) The facility shall document that appropriate training received by
direct child care staff includes, but is not limited to the following areas:
(g) Behavior management techniques, including crisis management and
passive physical restraint.
All staff who implement written orders for restraint or seclusion shall
have documented training in the proper use of the procedures, including
formal certification in control of aggression techniques, and this training
shall be documented in their personnel file. Training shall occur initially
and a minimum of two hours annually thereafter.
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Documentation
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A continuing log book shall be maintained by each provider that will
indicate, by name, the clients who have been placed in restraint or
seclusion, the date, and specified reason for restraint or seclusion, and
length of time in restraint or seclusion. The log book shall be signed and
dated by the R.N. on duty.
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Reporting
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None.
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Quality Improvement
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None.
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