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VIRGINIA |
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Standard or Definition |
Virginia Administrative Code:
12VAC35-105
As of June, 2003 |
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Restraint Definition |
"Restraint" means the use of an approved mechanical device, physical intervention or hands-on hold, or pharmacologic agent to involuntarily prevent an individual receiving services from moving his body to engage in a behavior that places him or others at risk. This term includes restraints used for behavioral, medical, or protective purposes. |
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Restraint Exclusions |
None. |
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Chemical Restraint Definition |
A "pharmacological restraint" means a drug that is given involuntarily for the emergency control of behavior when it is not standard treatment for the individual's medical or psychiatric condition. |
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Seclusion Definition |
"Seclusion" means the involuntary placement of an individual receiving services alone, in a locked room or secured area from which he is physically prevented from leaving. |
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Seclusion Exclusions |
Only inpatient hospital settings and residential facilities for children or adolescents licensed under the Mandatory Certification/Licensure Standards for Treatment Programs for Residential Facilities for Children (12VAC35-40-10 et seq.) of the Standards for Interdepartmental Regulation of Children's Residential Facilities (22VAC42-10-10 et seq.) may use seclusion. |
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Criteria for Restraint and Seclusion |
Providers shall not consider the use of seclusion or restraint unless other less restrictive techniques have been considered and documented in the individual's services plan to demonstrate that these less restrictive techniques did not or would not succeed in reducing or eliminating behaviors that are self-injurious or dangerous to other people.
Each individual is entitled to be completely free from any unnecessary use of seclusion, restraint, and time out.
Providers shall not use seclusion or restraint as punishment, reprisal, or for the convenience of staff.
Providers shall limit each authorization for seclusion or behavioral restraint to four hours for individuals 18 and older, two hours for children and adolescents ages 9 to 17, and one hour for children under age 9.
Providers shall ensure that seclusion and restraint may only be implemented, monitored, and discontinued by staff who have been trained in the proper and safe use of seclusion and restraint techniques.
Providers shall not utilize seclusion or restraint unless it is justified and carried out according to these regulations:
- The justification for any seclusion or restraint procedure must be documented in the individual's services plan.
- The authorization for the use of seclusion or restraint must be documented in the individual's services plan and include behavioral criteria the individual must meet for release.
- The authorization for the use of seclusion or restraint must be time-limited. Authorizations for the use of seclusion or restraint procedures may not be given on an as needed basis.
- The authorizing professional must document that he has taken into account any physical or psychological conditions that would place the individual at greater risk during restraint or seclusion.
Providers shall make sure that each individual who requires seclusion or restraint is given the opportunity for motion and exercise, to eat at normal meal times and take fluids, to use the restroom, and bathe as needed.
Providers who use seclusion and restraint may use seclusion or restraint if a qualified professional involved in providing services to the individual has, in advance:
- Assessed and documented why alternatives to the proposed use of seclusion or restraint have not been successful in changing the behavior or not attempted, taking into account the individual's medical and mental condition, behavior, preferences, nursing and medication needs, and ability to function independently;
- Determined that the proposed seclusion or restraint is necessary for effective treatment of the individual or to protect him or others from personal harm, injury, or death;
- Documented in the individual's service record the specific reasons for the seclusion or restraint; and
- Explained, so that the individual can understand, the reason for using restraint or seclusion, the criteria for its removal, the individual's right to a fair review of whether the restriction is permissible.
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Monitoring Requirements |
Providers shall make sure that the medical and mental condition of each individual in seclusion or restraint is continuously monitored by trained, qualified staff for the duration of the restriction. |
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Ordering and Initiation |
Providers who use seclusion and restraint may impose seclusion or restraint in an emergency, but only to the extent necessary to stop the emergency and only if:
- Less restrictive measures have been exhausted; or
- The emergency is so sudden that no less restrictive measure is possible.
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In-person Assessment |
Providers shall monitor the combined use of seclusion and restraint by a continuous face-to-face observation, not solely by an electronic surveillance device. |
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Debriefing |
Outcomes, including documentation of debriefing of the individual and staff involved following the incident shall be documented in the individual's record. |
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Family & Guardian Notification |
No information provided. |
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Notification of Rights and Restraint and Seclusion Policies and Procedures at admission |
No information provided. |
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Training |
No information provided. |
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Documentation |
Application of time out, seclusion and restraint shall be documented in the individual's record and, at a minimum, include:
- Physician's order;
- Date and time;
- Employees or contractors involved;
- Circumstances and reasons for use, including but not limited to other behavior management techniques attempted;
- Duration;
- Type of technique used; and
- Outcomes, including documentation of debriefing of the individual and staff involved following the incident.
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Reporting |
Incidents of seclusion and restraint, including the rationale, type and duration of the restraint, shall be reported to the department as provided in 12VAC35-115-230. |
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Quality Improvement |
Plans that include the use of seclusion and restraint shall be reviewed quarterly by the independent review committee and by the LHRC to assess if the use of restrictions has resulted in improvements in functioning. |
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