Restrictive Procedures Certification 2960.0710

1
Restrictive Procedures Certification2960.0710

• Certification required. A license holder who
  wishes to use a restrictive procedure with a
  resident must meet the requirements of this part
  to be certified to use restrictive procedures
  with a resident.

2
Restrictive Procedures Plan2960.0710 Subpart 2

• Plan must be approved by DOC or DHS
• The plan must provide at least the following
• A list of the restrictive procedures
• Description of the physical hold techniques used
  by the program

3
Restrictive Procedures Plan2960.0710 Subpart 2

• How the license holder will monitor and control
  the emergency use of restrictive procedures
• A description of the training that staff must
  have prior to them implementing the emergency use
  of restrictive procedures, which includes the
  following

4
Restrictive Procedures Plan2960.0710 Subpart 2C

• The needs and behaviors of residents
• Relationship building
• Alternatives to restrictive procedures
• De-escalation methods
• Avoiding power struggles

5
Restrictive Procedures Plan2060.0710 Subpart 2C

• Documentation standards for the use of
  restrictive procedures
• How to obtain emergency medical assistance
• Time limits for restrictive procedures
• Obtaining approval for the use of restrictive
  procedures

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Restrictive Procedures Plan2960.0710 Subpart 2C

• Requirement for updated training at least every
  other year
• The proper use of the restrictive procedures
  approved for the facility

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Restrictive Procedures Plan2960.0710 Subpart
2D

• Annual written review of the use of restrictive
  procedures by the license holder
• The license holder must ensure that the resident
  receives treatment for any injury caused by the
  use of restrictive techniques

8
DHS Licensed Facilities2960.0710 Subpart 3

• License holders who are licensed and certified by
  the Department of Human Services to provide
  residential treatment for children with a severe
  emotional disturbance and children in need of
  shelter care may seek certification to use one or
  more of the following restrictive procedures

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DHS Licensed Facilities2960.0710 Subpart 3

• physical escort
• physical holding
• seclusion and
• the limited use of mechanical restraint only for
  transporting a resident.

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DOC Licensed Facilities2960.0710 Subpart 4

• License holders who are licensed by the
  Department of Corrections may seek certification
  to use one or more of the following restrictive
  procedures

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DOC Licensed Facilities2960.0710 Subpart 4

• physical escort
• physical holding
• seclusion and
• mechanical restraints.

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DOC Licensed Facilities2960.0710 Subpart 4

• Disciplinary room time. Disciplinary room time
  may be secure or non-secure. Disciplinary room
  time may be used as a consequence for resident
  behavior as permitted in the facility's
  restrictive procedures plan. If disciplinary
  room time is used at the facility, the facility
  restrictive procedures plan must

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DOC Licensed Facilities2960.0710 Subpart 4

• provide for a system of due process for residents
  who violate facility rules
• contain a written set of facility rules of
  conduct which includes a description of the
  consequences or penalties for infractions of
  facility rules and

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DOC Licensed Facilities2960.0710 Subpart 4

• require that the written facility rules must be
  given to each resident and explained and made
  available to each resident at the time of
  admission. The facility rules must be explained
  to a resident in a language that the resident
  understands.

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Physical Escort Requirements2960.0710 Subpart 5

• The physical escort of a resident is intended to
  be a behavior management technique that is
  minimally intrusive to the resident.
• It is to be used to control a resident who is
  being guided to a place where the resident will
  be safe and to help de-escalate interactions
  between the resident and others.

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Physical Escort Requirements2960.0710 Subpart 5

• A license holder who uses physical escort with a
  resident must meet the following requirements
• staff must be trained according to subpart 2,
  item C

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Physical Escort Requirements 2960.0710 Subpart 5

• staff must document the use of physical escort
  and note the technique used, the time of day, and
  the name of the staff person and resident
  involved and
• the use of physical escort must be consistent
  with the resident's case plan or treatment plan.

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Use of Physical Holding or Seclusion 2960.0710
Subpart 6

• Physical holding and seclusion are behavior
  management techniques which are used in emergency
  situations as a response to imminent danger to
  the resident or others and when less restrictive
  interventions are determined to be ineffective.
  The emergency use of physical holding or
  seclusion must meet the conditions of items A to
  M

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Use of Physical Holding or Seclusion 2960.0710
Subpart 6

• an immediate intervention is necessary to protect
  the resident or others from physical harm
• the physical holding or seclusion used is the
  least intrusive intervention that will
  effectively react to the emergency

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Use of Physical Holding or Seclusion 2960.0710
Subpart 6

• the use of physical holding or seclusion must end
  when the threat of harm ends
• the resident must be constantly and directly
  observed by staff during the use of physical
  holding or seclusion

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Use of Physical Holding or Seclusion 2960.0710
Subpart 6

• the use of physical holding or seclusion must be
  used under the supervision of a mental health
  professional or the facility's program director
• physical holding and seclusion may be used only
  as permitted in the resident's treatment plan

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Use of Physical Holding or Seclusion 2960.0710
Subpart 6

• staff must contact the mental health professional
  or facility's program director to inform the
  program director about the use of physical
  holding or seclusion and to ask for permission to
  use physical holding or seclusion as soon as it
  may safely be done, but no later than 30 minutes
  after initiating the use of physical holding or
  seclusion

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Use of Physical Holding or Seclusion 2960.0710
Subpart 6

• before staff uses physical holding or seclusion
  with a resident, staff must complete the training
  required in subpart 2 regarding the use of
  physical holding and seclusion at the facility

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Use of Physical Holding or Seclusion2960.0710
Subpart 6

• when the need for the use of physical holding or
  seclusion ends, the resident must be assessed to
  determine if the resident can safely be returned
  to the ongoing activities at the facility

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Use of Physical Holding or Seclusion

• Staff must treat the resident with respect
• Staff who implemented the physical holding or
  seclusion must document its use immediately after
  the incident concludes
• Documentation must include
• Detailed description of the incident
• Why the procedure chosen needed to be used

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Use of Physical Holding or Seclusion

• Why less restrictive measures failed or were
  found to be inappropriate
• The time the physical hold began ended
• Document within 15 minutes intervals the
  residents behavioral change and any change in
  physical status that may result from the use of
  the procedure
• Names of all persons and witnesses involved

27
Use of Physical Holding or Seclusion

• Any room used for seclusion must be
• Well lighted
• Well ventilated
• Clean
• Have an observation window which allows direct
  monitoring of a resident
• Fixtures that are tamperproof
• Electrical switches located outside the door

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Use of Physical Holding or Seclusion

• Doors that open out and are unlocked or
• Are locked with keyless locks and have immediate
  release mechanisms.
• Objects that may cause injury must be removed
  from the resident and the room before a resident
  is placed for seclusion.

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Use of Mechanical Restraints

• A behavioral management device used only when
• transporting a resident
• in an emergency as a response to imminent danger
  to a resident or others
• Used only when less restrictive interventions are
  ineffective

30
Use of Mechanical Restraints

• A facility must include mechanical restraints as
  part of their restrictive procedures plan
• The use of mechanical restraints must meet the
  following conditions
• Necessary to protect resident or others from harm
• The least intrusive intervention to react to
  emergency

31
Use of Mechanical Restraints

• The mechanical restraint must end when the threat
  of harm ends
• The resident must be constantly and directly
  observed by staff during the use
• Use of the mechanical restraint must be approved
  by the Program Director or a designee
• May only be used as permitted in the residents
  treatment plan

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Use of Mechanical Restraints

• As soon as it may be safely done, but no later
  than 60 minutes after initiating use of a
  mechanical restraint, staff must contact the
  Program Director or designee to inform them about
  the use of the mechanical restraint and to ask
  permission to use the mechanical restraint
• Prior to using a mechanical restraint, staff must
  have training in the use and types of mechanical
  restraints used at the facility

33
Use of Mechanical Restraints

• When the need for the restraint ends, the
  resident must be accessed to determine if the
  resident can be safely returned to the ongoing
  activities at the facility
• The staff person(s) involved must document the
  use of the restraint immediately after the
  incident concludes

34
Use of Mechanical Restraints

• The documentation must include
• Detailed description of the incident
• Why the restraint was needed to prevent an
  immediate threat
• Why less restrictive measures failed or were
  found to be inappropriate
• The time the restraint began and ended

35
Use of Mechanical Restraints

• Document within 15 minutes intervals the
  residents behavioral change and any change in
  physical status that may result from the use of
  the restraint
• Names of all persons and witnesses involved in
  the use of the restraint

36
DOC-Disciplinary Room Time Use

• Disciplinary room time must be used only for
  major violations and be used according to the
  facility's restrictive procedures plan.

37
Disciplinary Room Time Use

• The license holder must also meet the following
  requirements to use DRT
• Staff give the resident written notice of the
  alleged violation of rule
• Resident must be advised of their right to be
  heard by an impartial party
• Resident must be advised of the right to an
  appeal the determination of the impartial party
  to a higher authority

38
Physical Holding or Seclusion- Additional Staff
Training

• Staff must also have the following training
• documentation standards for physical holding and
  seclusion
• thresholds for employing physical holding or
  seclusion
• the physiological and psychological impact of
  physical holding and seclusion

39
Physical Holding or Seclusion- Additional Staff
Training

• how to monitor and respond to the resident's
  physical signs of distress
• symptoms and interventions for positional
  asphyxia and
• time limits and procedures for obtaining approval
  of the use of physical holding and seclusion.
• Training must be updated every two years

40
Administrative Review

• License holder must complete administrative
  review of any use of a restrictive procedure
  within three (3) days after its use.
• The review must be completed by someone other
  than the person who decided to use the
  restrictive technique or their immediate
  Supervisor.

41
Administrative Review

• The resident and their representative must have
  the opportunity to present evidence/argument
  about the procedure.
• The record of the review of the restrictive
  procedure must include
• Required documentation was recorded
• Restrictive procedure was used per the treatment
  plan

42
Administrative Review

• Standards related to the restrictive procedure
  were met
• Staff was properly trained in the use of the
  restrictive procedure

43
Review Patterns of Use

• Quarterly the license holder must review patterns
  of the use of restrictive procedures
• The review must be done by the license holder or
  the facility advisory committee
• The review must consider
• Any patterns or problems in the use
• Any injuries
• Actions needed to correct deficiencies in the
  implementation of RT

44
Review Patterns of Use

• Actions needed to correct deficiencies in the
  programs implementation of RT
• An assessment of opportunities missed to avoid
  the use of RT
• Proposed actions to be taken to minimize the use
  of RT