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10.21.12.00.htm 10.21.12.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 21 MENTAL HYGIENE REGULATIONS Chapter 12 Use of Quiet Room and Use of Restraint Authority: Health-General Article, §10-101(e) and 10-701, Annotated Code of Maryland
10.21.12.01.htm 10.21.12.01. 01 Scope.. These regulations govern the use of quiet rooms and restraint in all facilities as defined in Health-General Article, §10-101(e) and 10-701, Annotated Code of Maryland. These regulations are supplemental to any other applicable law and regulation. In the event of conflict between these regulations and any other regulations or laws, the more stringent apply.
10.21.12.02.htm 10.21.12.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) Category I Restraint.. a) "Category I restraint" means a device identified by the facility which limits a patient's mobility to the extent that the patient would not be able to independently reposition himself or herself or would otherwise be rendered helpless in an emergency.b) "Category I restraint" includes, but is not limited to, four-point restraints and safety suits..
10.21.12.03.htm 10.21.12.03. 03 Use of Restraint.. A. Staff authorized under the provisions of Regulation .05A of this chapter shall use a restraint only to:1) Prevent and reduce serious, destructive, and damaging actions by a patient to the patient or to another;2) Prevent serious disruption of the therapeutic environment.. B. Staff may not use a restraint:. 1) As a mode or course of treatment;. 2) As punishment; or. 3) For convenience.. C. Staff shall use a restraint:.
10.21.12.04.htm 10.21.12.04. 04 Protective Device Use.. A. When the definition of a restraint or a protective device is in dispute, in each case under discussion, the clinical director or the clinical director's physician designee shall clarify and document in the patient's medical record the device's correct purpose.B. The patient's treatment team shall document in the treatment plan the team's rationale for use of a protective device.
10.21.12.05.htm 10.21.12.05. 05 Procedures in the Use of Restraint.. A. A physician who is responsible either for the care of the patient or for assessment of the appropriateness of a restraint or, when the appropriate physician is not readily available to assess the patient, a registered nurse shall conduct a clinical evaluation of the patient to determine:1) Whether an emergency situation is present; or. 2) The degree to which the patient presents a serious disruption to the therapeutic environment..
10.21.12.06.htm 10.21.12.06. 06 Placement of Patient in Restraint.. A. When possible, staff shall advise a patient, in a nonthreatening manner, that continuation of a specific behavior may result in the use of restraint.B. When a physician or registered nurse determines that the use of a restraint is appropriate, staff involved shall make a reasonable effort to verbally persuade the patient to be cooperative with the restraint.
10.21.12.07.htm 10.21.12.07. 07 Limitations and Placement of Children in Restraint.. In addition to the requirements outlined in this chapter, when:. A. Restraining a child, staff may not use four-point restraints; and. B. Applying or repositioning a restraint, staff shall avoid the application of force on long bone joints.
10.21.12.08.htm 10.21.12.08. 08 Clinical Interventions During Restraint.. A. Regardless of the physical setting in which the patient is placed, at a minimum, one staff member shall be assigned continuously while the patient is in a category I restraint.B. While the patient is restrained, in order to provide appropriate clinical care, at a minimum, staff clinically trained to do so shall:1) Keep the patient in full view at all times;. 2) Protect the patient from harm by others;. 3) Closely observe the pa
10.21.12.09.htm 10.21.12.09. 09 Limitations on Restraint and Continuous Restraint.. A. Staff may not initiate "standing" or "as needed" orders for restraint.. B. A physician may write an order for restraint for a period of up to, but not more than, 24 hours.. C. If a patient in restraint requires continuous restraint for over a 24-hour period, a physician shall:1) Conduct a face-to-face evaluation of the patient to determine whether continuous restraint is appropriate;
10.21.12.10.htm 10.21.12.10. 10 Documentation.. A. Restraint Orders. A physician shall:. 1) To initiate the use of restraint:. a) Enter an order in the patient's medical record; or. b) Authorize an order to be written by a registered nurse on the physician's order sheet in the patient's medical record:i) Indicating that physician's verbal order for restraint; or. ii) Directing the release of the patient and the rationale for that release;.
10.21.12.11.htm 10.21.12.11. 11 Use of Quiet Room.. A. Patient Request.. 1) A patient may request the use of a quiet room and, unless clinically contraindicated, may be granted use of a quiet room.2) Unless staff terminates use of the quiet room for clinical reasons, the patient may terminate self-initiated use of the quiet room at any time.B. Staff Request.. 1) When staff, permitted by the facility to initiate and terminate use of a quiet room, determine that the use of the quiet room is clinically indicat
10.21.12.12.htm 10.21.12.12. 12 Quality Assurance.. A. The clinical director or the clinical director's designee shall review daily all uses of restraint and investigate unusual or possibly unwarranted patterns of use.B. The physician involved in the restraint may not function in the capacity outlined in §A of this regulation.C. A facility shall identify a committee to review periodically, but not less than quarterly, the use of restraint to assure that the standards maintained by the facility are,
10.21.12.13.htm 10.21.12.13. 13 Procedures Pertaining to Complaints.. Complaints about the individual application of this chapter may be addressed through any patient grievance mechanism.
10.21.12.14.htm 10.21.12.14. 14 Variance with Standards.. A. Excluding the prohibition described in §B of this regulation, staff may not vary from the standards identified in this chapter unless the variation is for an extreme crisis.B. There may not be any variance with standards established in this regulation and in Regulations .03 and .04, .06B―G and I―J, .07, .09A, .11, .12A and D―F, .13, and .14 of this chapter.C. Staff shall document, on the facility's variance report, a variance with
10.21.12.9999.htm 10.21.12.9999. Administrative History Effective date: October 25, 1993 (20:21 Md. R. 1654).
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