section .1501 - use of physical restraints and alternatives

 

10A NCAC 13F .1501        USE OF PHYSICAL RESTRAINTS AND

ALTERNATIVES

(a)  An adult care home shall assure that a physical

restraint, any physical or mechanical device attached to or adjacent to the

resident's body that the resident cannot remove easily and which restricts

freedom of movement or normal access to one's body, shall be:

(1)           used only in those circumstances in which

the resident has medical symptoms that warrant the use of restraints and not

for discipline or convenience purposes;

(2)           used only with a written order from a

physician except in emergencies, according to Paragraph (e) of this Rule;

(3)           the least restrictive restraint that would

provide safety;

(4)           used only after alternatives that would

provide safety to the resident and prevent a potential decline in the

resident's functioning have been tried and documented in the resident's record.

(5)           used only after an assessment and care

planning process has been completed, except in emergencies, according to

Paragraph (d) of this Rule;

(6)           applied correctly according to the

manufacturer's instructions and the physician's order; and

(7)           used in conjunction with alternatives in an

effort to reduce restraint use.

Note:  Bed rails are restraints when used to keep a resident

from voluntarily getting out of bed as opposed to enhancing mobility of the

resident while in bed.  Examples of restraint alternatives are:  providing

restorative care to enhance abilities to stand safely and walk, providing a

device that monitors attempts to rise from chair or bed, placing the bed lower

to the floor, providing frequent staff monitoring with periodic assistance in

toileting and ambulation and offering fluids, providing activities, controlling

pain, providing an environment with minimal noise and confusion, and providing

supportive devices such as wedge cushions.

(b)  The facility shall ask the resident or resident's legal

representative if the resident may be restrained based on an order from the

resident’s physician.  The facility shall inform the resident or legal

representative of the reason for the request and the benefits of restraint use

and the negative outcomes and alternatives to restraint use.  The resident or

the resident's legal representative may accept or refuse restraints based on

the information provided.  Documentation  shall consist of a statement signed

by the resident or the resident's legal representative indicating the signer

has been informed, the signer's acceptance or refusal of restraint use and, if

accepted, the type of restraint to be used and the medical indicators for

restraint use.

Note:  Potential negative outcomes of restraint use include

incontinence, decreased range of motion, decreased ability to ambulate,

increased risk of pressure ulcers, symptoms of withdrawal or depression and

reduced social contact.

(c)  In addition to the requirements in Rules 13F .0801,

.0802 and .0903 of this Subchapter regarding assessments and care planning, the

resident assessment and care planning prior to application of restraints as

required in Subparagraph (a)(5) of this Rule shall meet the following

requirements:

(1)           The assessment and care planning shall be

implemented through a team process with the team consisting of at least a staff

supervisor or personal care aide, a registered nurse, the resident and the

resident's responsible person or legal representative.  If the resident or

resident's responsible person or legal representative is unable to participate,

there shall be documentation in the resident's record that they were notified

and declined the invitation or were unable to attend.

(2)           The assessment shall include consideration

of the following:

(A)          medical symptoms that warrant the use of a

restraint;

(B)           how the medical symptoms affect the resident;

(C)           when the medical symptoms were first observed;

(D)          how often the symptoms occur;

(E)           alternatives that have been provided and the

resident's response; and

(F)           the least restrictive type of physical restraint

that would provide safety.

(3)           The care plan shall include the following:

(A)          alternatives and how the alternatives will be used

prior to restraint use and in an effort to reduce restraint time once the

resident is restrained;

(B)           the type of restraint to be used; and

(C)           care to be provided to the resident during the time

the resident is restrained.

(d)  The following applies to the restraint order as

required in Subparagraph (a)(2) of this Rule:

(1)           The order shall indicate:

(A)          the medical need for the restraint;

(B)           the type of restraint to be used;

(C)           the period of time the restraint is to be used; and

(D)          the time intervals the restraint is to be checked

and released, but no longer than every 30 minutes for checks and two hours for

releases.

(2)           If the order is obtained from a physician

other than the resident's physician, the facility shall notify the resident's

physician of the order within seven days.

(3)           The restraint order shall be updated by the

resident's physician at least every three months following the initial order.

(4)           If the resident's physician changes, the

physician who is to attend the resident shall update and sign the existing

order.

(5)           In emergency situations, the administrator

or administrator-in-charge shall make the determination relative to the need

for a restraint and its type and duration of use until a physician is

contacted.  Contact with a physician shall be made within 24 hours and

documented in the resident's record.

(6)           The restraint order shall be kept in the

resident's record.

(e)  All instances of the use of physical restraints and

alternatives shall be documented by the facility in the resident's record and

include the following:

(1)           restraint alternatives that were provided

and the resident's response;

(2)           type of restraint that was used;

(3)           medical symptoms warranting restraint use;

(4)           the time the restraint was applied and the

duration of restraint use;

(5)           care that was provided to the resident

during restraint use; and

(6)           behavior of the resident during restraint

use.

(f)  Physical restraints shall be applied only by staff who

have received training according to Rule .0506 of this Subchapter and been

validated on restraint use according to Rule .0504 of this Subchapter.

 

History Note:        Authority G.S. 131D-2; 143B-165; S.L.

2002-0160; 2003-0284;

Temporary Adoption Eff. July 1, 2004;

Temporary Adoption Expired March 12, 2005;

Eff. June 1, 2005.