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10.21.13.00.htm 10.21.13.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 21 MENTAL HYGIENE REGULATIONS Chapter 13 Use of Quiet Room and Use of Seclusion Authority: Health-General Article, §10-101(e) and 10-701, Annotated Code of Maryland
10.21.13.01.htm 10.21.13.01. 01 Scope.. These regulations govern the use of quiet rooms and seclusion 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.
10.21.13.02.htm 10.21.13.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Chief executive officer (CEO) means the individual responsible for the overall management of a facility.2) "Clinical director" means the psychiatrist in charge of the clinical care of all psychiatric patients in that facility.3) "Emergency situation" means any situation in which a patient's behavior poses a serious and imminent danger to the physical safety of self or other
10.21.13.03.htm 10.21.13.03. 03 Use of Seclusion.. A. Staff authorized under the provisions of Regulation .04A of this chapter shall use seclusion only to:1) Prevent and reduce serious, destructive, and damaging actions by a patient to the patient or to another; or2) Prevent serious disruption of the therapeutic environment.. B. Staff may not use seclusion:. 1) As a mode or course of treatment;. 2) As punishment; or. 3) For the convenience of staff.. C. Staff shall conduct seclusion:.
10.21.13.04.htm 10.21.13.04. 04 Procedures in the Use of Seclusion.. A. A physician who is responsible either for the care of the patient or for assessment of the appropriateness of seclusion 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..
10.21.13.05.htm 10.21.13.05. 05 Placement of a Patient in a Seclusion Room.. A. When possible, staff shall advise a patient, in a nonthreatening manner, that continuation of a specific behavior may result in the use of seclusion.B. When a physician or registered nurse determines that the use of seclusion is appropriate, staff involved shall make a reasonable effort to verbally persuade the patient to enter the seclusion room.C. To the extent consistent with the patient's safety and the safety of others:.
10.21.13.06.htm 10.21.13.06. 06 Clinical Interventions During Seclusion.. A. While the patient is secluded, in order to provide appropriate clinical care, at a minimum, clinically trained staff shall:1) Observe the patient at least every 15 minutes, and document each observation by the observer;. 2) Unless contraindicated by circumstances as assessed and documented by a physician or registered nurse, at least hourly, make and document personal contact with the patient for the purpose of determ
10.21.13.07.htm 10.21.13.07. 07 Limitations on Seclusion and Continuous Seclusion.. A. Staff may not initiate "standing" or "as needed" orders for seclusion.. B. Excluding requirements outlined in §D of this regulation, each order or subsequent order for seclusion may be written for a period up to, but not more than, 24 hours.C. If a patient in seclusion requires continuous seclusion for over a 24-hour period, a physician shall:1) Conduct a face-to-face evaluation of the patient to determine whether co
10.21.13.08.htm 10.21.13.08. 08 Documentation.. A. Seclusion Orders. A physician shall:. 1) To initiate the use of seclusion:. 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 seclusion; or. ii) Directing the release of the patient and the rationale for that release;.
10.21.13.09.htm 10.21.13.09. 09 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
10.21.13.10.htm 10.21.13.10. 10 Quality Assurance.. A. The clinical director or the clinical director's designee shall review daily all uses of seclusion and investigate unusual or possibly unwarranted patterns of use.B. The physician involved in the seclusion 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 seclusion to assure that the standards maintained by the facility are,
10.21.13.11.htm 10.21.13.11. 11 Procedures Pertaining to Complaints.. Complaints about the individual application of this chapter may be addressed through any patient grievance mechanism.
10.21.13.12.htm 10.21.13.12. 12 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, .05B―E and G, .07A, .09, .10A, D, E(1) and F, .11, and .12 of this chapter.C. Staff shall document, on the facility's variance report, a variance with
10.21.13.9999.htm 10.21.13.9999. Administrative History Effective date: October 25, 1993 (20:21 Md. R. 1654).
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