.14 Physical and Chemical Restraints.

A. Physical restraints may be used only:

(1) As an integral part of an individual medical treatment plan;

(2) If absolutely necessary to protect the resident or others from injury;

(3) If prescribed by a physician or administered by another health care professional practicing within the scope of their license; and

(4) If less restrictive alternatives were considered and appropriately ruled out by the physician.

B. Use of Physical Restraints.

(1) When a facility uses physical restraints, personnel:

(a) Trained in the use of restraints shall check a resident in restraint at least every 2 hours, and maintain a record of the checks and usage; and

(b) Shall provide opportunities for motion and exercise during each 2-hour period in which physical restraint is used, and shall monitor the use of the restraint use and maintain a record of it.

(2) The attending physician shall ensure that treatment plans include provisions for the progressive elimination of physical restraints.

C. Use of Psychopharmacologic Drugs. When a physician prescribes psychopharmacologic drugs for a resident, the resident's clinical records shall contain all of the following documentation:

(1) A physician's indication that the dosage, duration, indication, and monitoring are clinically appropriate and the reasons why they are clinically appropriate;

(2) Indication that the resident is being monitored for adverse complications of the drug therapy;

(3) Confirmation that previous attempts at dosage reduction have been unsuccessful, if applicable;

(4) Evidence of the resident's subjective or objective improvement, or maintenance or function, while taking the medication;

(5) Evidence that the resident's decline or deterioration, if applicable, has been evaluated by the interdisciplinary team to determine whether a particular drug, a particular dosage, or duration of therapy may be the cause;

(6) Evidence of why the resident's age, weight, or other factors would require a unique drug dose, drug duration, indication, or monitoring; or

(7) Other evidence that substantiates the use of the restraint.