Ariz. Admin. Code § R9-10-2217 - Restraint

If a nursing-supported group home is authorized to provide restraint, an administrator shall ensure that:

1. Policies and procedures for providing restraint are established, documented, and implemented to protect the health and safety of a resident that:

a. Establish the process for resident assessment, including identification of a resident's medical conditions and criteria for the on-going monitoring of any identified medical condition;

b. Identify each type of restraint used and include for each type of restraint used:

i. The qualifications of a personnel member who can:

(1) Order the restraint,

(2) Place a resident in the restraint,

(3) Monitor a resident in the restraint,

(4) Evaluate a resident's physical and psychological well-being after being placed in the restraint and when released from the restraint, or

(5) Renew the order for restraint;

ii. On-going training requirements for a personnel member who has direct resident contact while the resident is in a restraint; and

iii. Criteria for monitoring and assessing a resident including:

(1) Frequencies of monitoring and assessment based on a resident's medical condition and risks associated with the specific restraint;

(2) For the renewal of an order for restraint, whether an assessment is required before the order is renewed and, if an assessment is required, who may conduct the assessment;

(3) Assessment content, which may include, depending on a resident's condition, the resident's vital signs, respiration, circulation, hydration needs, elimination needs, level of distress and agitation, mental status, cognitive functioning, neurological functioning, and skin integrity;

(4) If a mechanical restraint is used, how often the mechanical restraint is loosened; and

(5) A process for meeting a resident's nutritional needs and elimination needs;

c. Establish the criteria and procedures for renewing an order for restraint;

d. Establish procedures for internal review of the use of restraint; and

e. Establish medical record and personnel record documentation requirements for restraint, if applicable;

2. An order for restraint is:

a. Obtained from a physician or registered nurse practitioner, and

b. Not written as a standing order or on an as-needed basis;

3. Restraint is:

a. Not used as a means of coercion, discipline, convenience, or retaliation;

b. Only used when all of the following conditions are met:

i. Except as provided in subsection (4), after obtaining an order for the restraint;

ii. For the management of a resident's aggressive, violent, or self-destructive behavior;

iii. When less restrictive interventions have been determined to be ineffective; and

iv. To ensure the immediate physical safety of the resident, to prevent imminent harm to the resident or another individual, or to stop physical harm to another individual; and

c. Discontinued at the earliest possible time;

4. If as a result of a resident's aggressive, violent, or self-destructive behavior, harm to the resident or another individual is imminent or the resident or another individual is being physically harmed, a personnel member:

a. May initiate an emergency application of restraint for the resident before obtaining an order for the restraint, and

b. Obtains an order for the restraint of the resident during the emergency application of the restraint;

5. An order for restraint includes:

a. The name of the physician or registered nurse practitioner ordering the restraint;

b. The date and time that the restraint was ordered;

c. The specific restraint ordered;

d. If a drug is ordered as a chemical restraint, the drug's name, strength, dosage, and route of administration;

e. The specific criteria for release from restraint without an additional order; and

f. The maximum duration authorized for the restraint;

6. An order for restraint is limited to the duration of the emergency situation and does not exceed three continuous hours;

7. If an order for restraint of a resident is not provided by the resident's designated medical practitioner, the resident's designated medical practitioner is notified as soon as possible;

8. A medical practitioner or personnel member does not participate in restraint, assess or monitor a resident during restraint, or evaluate a resident after restraint, and a physician or registered nurse practitioner does not order restraint, until the medical practitioner or personnel member, completes education and training that:

a. Includes:

i. Techniques to identify medical practitioner, personnel member, and resident behaviors, events, and environmental factors that may trigger circumstances that require restraint;

ii. The use of nonphysical intervention skills, such as de-escalation, mediation, conflict resolution, active listening, and verbal and observational methods;

iii. Techniques for identifying the least restrictive intervention based on an assessment of the resident's medical or behavioral health condition;

iv. The safe use of restraint, including training in how to recognize and respond to signs of physical and psychological distress in a resident who is restrained or secluded;

v. Clinical identification of specific behavioral changes that indicate that the restraint is no longer necessary;

vi. Monitoring and assessing a resident while the resident is in restraint according to policies and procedures; and

vii. Except for the medical practitioner, training exercises in which the personnel member successfully demonstrates the techniques that the medical practitioner or personnel member has learned for managing emergency situations; and

b. Is provided by individuals qualified according to policies and procedures;

9. When a resident is placed in restraint:

a. The restraint is conducted according to policies and procedures;

b. The restraint is proportionate and appropriate to the severity of the resident's behavior and the resident's:

i. Chronological and developmental age;

ii. Size;

iii. Gender;

iv. Physical condition;

v. Medical condition;

vi. Psychiatric condition; and

vii. Personal history, including any history of physical or sexual abuse;

c. The physician or registered nurse practitioner who ordered the restraint is available for consultation throughout the duration of the restraint;

d. The resident is monitored and assessed according to policies and procedures;

e. A physician or registered nurse assesses the resident within one hour after the resident is placed in the restraint and determines:

i. The resident's current behavior,

ii. The resident's reaction to the restraint used,

iii. The resident's medical and behavioral condition, and

iv. Whether to continue or terminate the restraint;

f. The resident is given the opportunity:

i. To eat during mealtime, and

ii. To use the toilet; and

g. The restraint is discontinued at the earliest possible time, regardless of the length of time identified in the order;

10. A medical practitioner or personnel member documents the following information in a resident's medical record before the end of the shift in which the resident is placed in restraint or, if the resident's restraint does not end during the shift in which it began, during the shift in which the resident's restraint ends:

a. The emergency situation that required the resident to be restrained,

b. The times the resident's restraint actually began and ended,

c. The monitoring required in subsection (9)(d),

d. The time of the assessment required in subsection (9)(e),

e. The names of the medical practitioners and personnel members with direct resident contact while the resident was in the restraint,

f. The times the resident was given the opportunity to eat or use the toilet according to subsection (9)(f), and

g. The resident evaluation required in subsection (12);

11. If an emergency situation continues beyond the time limit of an order for restraint, the order is renewed according to policies and procedures that include:

a. The specific criteria for release from restraint without an additional order, and

b. The maximum duration authorized for the restraint; and

12. A resident is evaluated after restraint is no longer being used for the resident.

Notes

Ariz. Admin. Code § R9-10-2217

New Section made by final exempt rulemaking at 28 A.A.R. 927, effective 4/15/2022.