WAC 246-337-110   Use of seclusion and restraint.  Any RTF that utilizes restraint or seclusion must ensure that restraint or seclusion is performed in compliance with chapters 70.96A, 71.05, 71.34 RCW, this chapter, and other applicable federal and state laws and rules. Restraint and seclusion must be performed in a manner that is safe, proportionate and appropriate to the severity of the behavior, the resident's chronological and developmental age, size, gender, physical, medical and psychiatric condition, and personal history.

     (1) The licensee may use seclusion or restraint only in emergency situations needed to ensure the physical safety of the individual resident or other residents or staff of the facility, and when less restrictive measures have been found to be ineffective to protect the resident or others from harm.

     (2) Seclusion and restraint procedures must be implemented in the least restrictive manner possible in accordance with a written modification to the resident's health care plan and discontinued when the behaviors that necessitated the restraint or seclusion are no longer in evidence.

     (3) "Whenever needed" or "as needed" (PRN) orders for use of seclusion or restraint are prohibited.

     (4) A physician or other authorized health care provider must authorize use of the restraint or seclusion within one hour of initiating the restraint or seclusion.

     (5) Each order of restraint or seclusion is limited in length of time to:

     (a) Adults: Four hours;

     (b) Children and adolescents ages nine to seventeen: Two hours; and

     (c) Children under nine years of age: One hour.

     (6) A physician or an authorized health care provider, authorized by the licensee, may only renew the original order in accordance with these limits for up to a total of twenty-four hours.

     (7) A physician or an authorized health care provider must examine the resident, before the restraint or seclusion exceeds more than twenty-four hours. This procedure must be repeated for each subsequent twenty-four hour period of restraint or seclusion.

     (8) Within one hour of initiation of restraint or seclusion, an authorized health care provider must conduct a face-to-face assessment of the physical and psychological well-being of the resident.

     (9) The resident's clinical record must include the following documentation should restraint or seclusion be used:

     (a) Order for the restraint or seclusion including name of the physician or authorized health care provider authorizing restraint or seclusion;

     (b) Date/time order obtained;

     (c) The specific intervention ordered including length of time and behavior that would terminate the intervention;

     (d) Time restraint or seclusion began and ended;

     (e) Time and results of one hour assessment;

     (f) Resident behavior prior to initiation of restraint or seclusion;

     (g) Any injuries sustained during the restraint or seclusion; and

     (h) Post intervention debriefing with resident to discuss precipitating factors leading to the need for intervention.

     (10) Safety health checks must be conducted and documented at a minimum of every fifteen minutes, to include:

     (a) Behavior;

     (b) Food/nutrition offered;

     (c) Toileting; and

     (d) Physical condition.

     (11) Staff shall continuously observe and monitor residents in seclusion or restraint by an assigned staff member (face-to-face) or by staff using both video and audio equipment.

     (12) Staff involved in the restraint or seclusion will debrief and address effectiveness and safety issues.

     (13) The licensee must ensure that restraint and seclusion is carried out in a safe environment. This room must:

     (a) Be designed to minimize potential for stimulation, escape, hiding, injury, or death;

     (b) Have a maximum capacity of one resident;

     (c) Have a door that opens outward;

     (d) Have a staff-controlled, lockable, adjoining toilet room;

     (e) Have a minimum of three feet of clear space on three sides of the bed; and

     (f) Have negative pressure with an independent exhaust system with the exhaust fan at the discharge end of the system.

     (14) Restraint equipment must be clean and in good repair.



[Statutory Authority: Chapter 71.12 RCW. 05-15-157, § 246-337-110, filed 7/20/05, effective 8/20/05.]