(1)The maximum time limit for each restraint or seclusion order — before consideration of a renewal, and up to a maximum of 24 hours — is as follows:
(a)4 hours for adults 18 years of age or older;
(b)2 hours for children and adolescents 9 to 17 years of age; or
(c)1 hour for children under 9 years of age.
(2)Orders may be renewed according to time limits for a maximum 24 hours verbally, by telephone, facsimile, or thru a computerized medical record. After each 24 hours of continuous restraint or seclusion, and prior to further extension of the restraint or seclusion, an examination and second opinion must occur by a second physician.
(3)The physician responsible for the care of the patient shall examine a person within 24 hours of the administration of seclusion or restraint and the person must be examined by a nurse every two hours until such time as the physician examines the person and either makes new orders for seclusion nor restraint or for releasing the patient from seclusion or restraint. The physician must document reasons for the use of the seclusion or restraint over the physician’s signature.
(4)A physician shall not order physical restraint on an as required basis, i.e. a physician shall not make “p.r.n.” orders for physical restraint.
(5)No form of restraint shall be used as punishment, for the convenience of staff, or as a substitute for activities, treatment or training.
(6)Medication will not be used as a restraint, but will be prescribed and administered according to acceptable medical, nursing and pharmaceutical practices.
(7)Patients shall not be permitted to use restraint on other patients.
(8)Physical restraint must be used in accordance with sound medical practice to assure the least risk of physical injury and discomfort. Any patient placed in physical restraint shall be protected from self-injury and from injury by others.
(9)15 Minute Checks:
(a)A patient in restraint or seclusion must be checked at least every 15 minutes.
(b)15 minute checks include circulation checks, during waking hours adequate range of motion, and partial release of restraint to permit motion and exercise without endangering the patient or staff.
(c)Attention must be paid to the patient’s basic personal needs (such as regular meals, personal hygiene and sleep) as well as the person’s need for good body alignment and circulation.
(d)Staff must document that the patient was checked and appropriate attention paid to the person’s needs.
(e)The patient must be released as soon as the patient is assessed by a nurse, physician, or nurse practitioner to not present imminent dangerousness to themselves or others.
Rule 309-033-0732 — Time Limits,