| |
OHIO |
|
Standard or Definition |
Ohio Administrative Code
Chapter 5122-26
As of June, 2003 |
|
Restraint Definition |
"Restraint" means any method of physically restricting a patient's freedom of movement, physical activity, or normal access to his or her body. |
|
Restraint Exclusions |
The requirements for the use of mechanical restraint and/or seclusion do not apply:
- Restraint use that is only associated with medical, dental, diagnostic, or surgical procedures and is based on standard practice for the procedure. Such standard practice may or may not be described in procedure or practice descriptions (e.g., the requirements do not apply to medical immobilization in the form of surgical positioning, iv arm boards, radiotherapy procedures, electroconvulsive therapy, etc.)
- When a device is used to meet the assessed needs of an individual who requires adaptive support (e.g., postural support, orthopedic appliances) or protective devices (e.g., helmets, tabletop chairs, bed rails, car seats). Such use is always based on the assessed needs of the individual. Periodic reassessment should assure that the restraint continues to meet an identified individual need
- To physical restraint, time-out or comforting of children when its use is consistent with rules 5122-26-16 to 5122-26-16.3 of the Administrative Code
- To forensic and corrections restrictions used for security purposes, i.e., for custody, detention, and public safety reasons, and when not involved in the provision of health care.
|
|
Chemical Restraint Definition |
No definition given. |
|
Seclusion Definition |
"Seclusion" means the involuntary confinement of a patient alone in a room where the patient is physically prevented from leaving. |
|
Seclusion Exclusions |
See "Restraint Exclusions" above. |
|
Criteria for Restraint and Seclusion |
Restraint:
Physical restraint may be used as a response to an emergency only.
Mechanical restraint and seclusion shall be used only when there exists an immediate risk of danger to the individual or others and no other safe and effective intervention is possible.
Seclusion:
The type of room in which seclusion is employed shall ensure:
- Appropriate temperature control, ventilation and lighting
- The presence of an observation window and, if necessary, wall mirror(s) so that all areas of the room are observable by staff from outside of the room
- That any furniture present is removable or is securely fixed for safety reasons.
|
|
Monitoring Requirements |
Physical Restraint:
No information provided.
Mechanical Restraint and Seclusion:
While in mechanical restraint and/or seclusion, persons shall be continuously monitored, i.e., constant visual observation by staff in a manner most conducive to the situation and/or person's condition. Documentation of the condition of the person shall be made in the clinical record at routine intervals not to exceed fifteen minutes or more often if the person's condition so warrants. Such documentation shall address attention to needs regarding meals, fluid intake, hygiene, toileting, ambulation and other needs, as necessary, and the appropriate actions taken. |
|
Ordering and Initiation |
Physical restraint:
Provisions of this rule shall be carried out by qualified staff only.
Mechanical restraint and seclusion:
Orders shall be written only by a psychiatrist or other physician with specific clinical privileges or authorization granted by the agency for implementation of mechanical restraint and seclusion. In an emergency:
- Mechanical restraint and/or seclusion may be implemented by staff at the direction and in the presence of a registered nurse.
- A verbal order from a psychiatrist or other physician with specific clinical privileges or authorization granted by the agency shall be obtained by the registered nurse upon implementation of mechanical restraint or seclusion or within one hour. Such orders shall be signed by a psychiatrist or other physician with specific clinical privileges or authorization granted by the agency within twenty-four hours.
|
|
In-person Assessment |
Mechanical restraint and seclusion:
After the original order for mechanical restraint and/or seclusion expires, the individual shall receive a face-to-face reassessment by the psychiatrist or other physician with specific clinical privileges or authorization granted by the agency, who shall write a new order if mechanical restraint or seclusion is to be continued. However, agency policy and the original order may permit a registered nurse to perform such reassessment and make a decision to continue the original order for an additional:
- Two hours for children and adolescents age nine to eighteen up to a maximum of twenty-four hours; or
- One hour for children under age nine up to a maximum of twenty-four hours.
|
|
Debriefing |
Upon conclusion of mechanical restraint and/or seclusion interventions, staff shall meet with the individual for the purpose of:
- Assisting the individual to develop an understanding of the precipitants which may have evoked the behaviors necessitating the use of the intervention(s);
- Assisting the individual to develop appropriate coping mechanisms or alternate behaviors that could be effectively utilized should similar situations/emotions/thoughts present themselves again; and
- Developing and documenting a specific plan of intervention(s) for inclusion in the ITP/ISP, with the intent to avert future need for mechanical restraint and/or seclusion.
|
|
Family & Guardian Notification |
No information provided. |
|
Notification of Rights and Restraint and Seclusion Policies and Procedures at admission |
No information provided. |
|
Training |
Training for staff implementing physical restraint shall include but not be limited to:
- Current certification in CPR and first aid.
- The identification and utilization of less restrictive alternatives. Training of staff shall focus upon identifying the earliest precipitant of aggression for patients/clients with a known, suspected, or present history of aggressiveness, and on developing treatment strategies to prevent exacerbation or escalation of these behaviors. Patient/client involvement in the identification of precipitants is paramount.
Each member shall experience physical restraint and/or mechanical restraint and seclusion as part of the training. |
|
Documentation |
Physical Restraint:
Documentation of each episode of the use of physical restraint shall be made in the clinical record and shall include:
- Reason for implementation of the physical restraint
- Less restrictive interventions attempted first, if the situation allowed
- Notation that a review and description of any known contraindications for the use of physical restraint was conducted
- Explanation to the person for the reason for implementation of physical restraint and the required behaviors of the person which would indicate sufficient behavioral control so that the physical restraint could be discontinued
- Upon conclusion of the physical restraint, assessment of the need for ambulating, fluid intake, toileting, and other needs
- Results of a check for injury
- Documentation of staff's efforts to process the circumstances surrounding the physical restraint with the individual
- Notation of any concerns for the subsequent utilization of physical restraint
Mechanical restraint and seclusion:
Upon any implementation of mechanical restraint or seclusion, a registered nurse, psychiatrist, or other physician with specific clinical privileges or authorization granted by the agency shall:
- Perform and document in the clinical record an assessment, including the reason(s) for mechanical restraint or seclusion, prior attempts to use less restrictive interventions, review of any contra-indications for mechanical restraint use or seclusion, and review of all current medications
- Assess and document vital signs including temperature, pulse, respiration and blood pressure
- Explain to the individual the reason for mechanical restraint or seclusion, and the required behaviors of the individual which would indicate sufficient behavioral control so that mechanical restraint or seclusion can be discontinued
|
|
Reporting |
An incident reporting system shall be developed to require written reports of incidents and major unusual incidents that pose a danger to the health and safety of persons served and staff of the agency.
Written incident reports shall be submitted to and reviewed by the executive director of the agency or designee.
Review of written incident reports and corrective action taken, if any, shall be included in quality assurance activities.
A copy of all major unusual incident reports related to the agency shall be sent to the agency director and the community mental health board within twenty-four hours after the event occurs.
The agency shall receive and review all major unusual incident reports from licensed residential facilities regarding persons served by the agency, and shall take action, as appropriate, and according to rule 5122:3-5-01 of the Administrative Code. |
|
Quality Improvement |
No information provided. |
 Back to Top  Printer-friendly Page  Contact Us
|
|
