.18 Restraint or Seclusion.

A. A hospice house shall develop a policy and procedure related to restraint and seclusion.

B. Relevant staff shall be trained in accordance with the facilityís policy and procedure related to restraint and seclusion.

C. Patients have the right to be free from restraint or seclusion of any form which are imposed as a means of coercion, discipline, convenience, or retaliation by staff.

D. Restraint or seclusion may only be imposed to ensure the immediate physical safety of the patient, a staff member, or others and shall be discontinued at the earliest possible time.

E. The type or technique of restraint or seclusion used shall be the least restrictive intervention that will be effective to protect the patient, a staff member, or others from harm.

F. The use of restraint or seclusion shall be:

(1) In accordance with a written modification to the patientís plan of care; and

(2) Implemented in accordance with safe and appropriate restraint and seclusion techniques as determined by hospice policy in accordance with applicable laws.

G. All restraints shall be ordered by a physician and shall specify:

(1) The purpose of the restraint;

(2) The type of restraint to be used; and

(3) The length of time the restraint shall be used.

H. Restraint and seclusion orders may not be on an as-needed basis.

I. A patient may not remain in a restraint for more than 2 hours without a change in position and toileting opportunity.

J. The patientís primary hospice nurse or hospice nurse on call and hospice medical director or physician designee shall be consulted as soon as possible after the implementation of any restraint or seclusion to, as applicable:

(1) Review and modify the plan of care; and

(2) Determine if the hospice house is an appropriate setting for the patient at this time.

K. The program shall notify the patientís family or the patientís representative each time a restraint is used.