(1) Chemical Restraint: A medication that is
prescribed to restrict the service recipient's freedom of movement for the
control of extreme violent physical behavior. Chemical restraints are
medications used in addition to, or in replacement of, the service recipient's
regular drug regimen to control extreme violent physical behavior. The
medications that comprise the service recipient's regular medical regimen
(including PRN medications) are not considered chemical restraints, even if
their purpose is to treat ongoing behavioral symptoms.
(2) Conservator: A court appointed
conservator or a Veterans Administration guardian.
(3) Hospital: A licensed public or private
inpatient treatment resource or hospital or a part of a hospital that provides
inpatient care and treatment for persons with mental illness or serious
emotional disturbance.
(4)
Isolation: The confinement of a service recipient alone in a room or an area
where the service recipient is physically prevented from leaving. This
definition is not limited to instances in which a service recipient is confined
by a locked or closed door. This definition explicitly excludes the segregation
of a service recipient for the purpose of managing biological contagion
consistent with the Centers for Disease Control Guidelines.
Isolation does not include confinement to a locked unit or
ward where other individuals are present. Isolation is not solely confinement
of a service recipient to an area, but separation of the service recipient from
other persons.
Isolation does not include time-out, which is a behavior
management procedure in which, contingent upon the demonstration of undesired
behavior, the opportunity for positive reinforcement is withheld, which may
involve the voluntary separation of the individual service recipient from
others.
(5) Licensed
Independent Practitioner: An individual licensed by the Tennessee Health
Related Boards as a:
(a) medical
doctor;
(b) doctor of
osteopathy;
(c) physician
assistant;
(d) certified nurse
practitioner;
(e) nurse with a
masters degree in nursing who functions as a psychiatric nurse;
(f) psychologist with health service provider
designation;
(g) licensed clinical
social worker;
(h) licensed
professional counselor;
(i) senior
psychological examiner;
(j)
psychological examiner
(k) marriage
and family therapist; or
(l) other
licensed mental health professional who is permitted by law to practice
independently.
In addition, to be considered a licensed independent
practitioner for purposes of this chapter, the individual must be privileged by
the hospital medical staff and governing body to authorize the use of isolation
and restraint.
(6)
Licensed Mental Health Professional: For purposes of this chapter, a licensed
mental health professional is an individual who meets the requirements in the
definition of Licensed Independent Practitioner or who is licensed by the
Tennessee Health Related Boards as a registered nurse, licensed practical
nurse, or substance abuse counselor.
(7) Medical Director: The physician
designated to have overall responsibility for the provision of psychiatric care
at the hospital. If the Medical Director is the treating physician, the chief
officer must appoint an alternate for review purposes under this
chapter.
(8) Physical Restraint:
Any method, including physical holding or use of a mechanical device, material,
or equipment attached or adjacent to an individual service recipient's body,
that he or she cannot easily remove, and that restricts freedom of movement or
normal access to one's body. There are two types of physical restraint:
(a) Physical Holding: The use of staff body
contact with a service recipient in order to restrict freedom of movement or
normal access to one's body.
Physical holding does not include the use of physical touch
associated with prompting, comforting or assisting that does not prevent the
individual service recipient's freedom of movement or normal access to his or
her body. In addition, physical holding does not include "physical escort"
which means the temporary touching or holding of the hand, wrist, arm, shoulder
or back for the purpose of inducing the individual to walk to a safe
location.
(b) Mechanical
Restraint: For purposes of this chapter, the application of a mechanical
device, material, or equipment attached or adjacent to the service recipient's
body that the service recipient cannot easily remove and that restricts freedom
of movement or normal access to the service recipient's body. This includes the
use of ambulatory restraint devices except as noted under the other exceptions
below.
For purposes of this chapter, physical restraint does not
include the use of:
1. any restrictive
devices or manual methods employed by a law enforcement agent or other public
safety officer to maintain custody, detention, or public safety during the
transport of an individual under the jurisdiction of the criminal justice
system or juveniles with charges in the juvenile justice system; or
2. restraints for medical immobilization,
adaptive support, or medical protection; or
3. restrictive devices administratively
authorized to ensure the safety of the service recipient or others when an
involuntary committed service recipient must be transported; or
4. restrictive mechanical ambulatory devices
used for the service recipient who:
(i)
exhibits intractable behavior which is severely self-injurious or injurious to
others, and
(ii) has not responded
to usual and customary interventions, and
(iii) has restrictive mechanical ambulatory
devices provided for and carried out in conformity with the service recipient's
behavioral plan in the individualized treatment plan.
This behavioral plan must be re-evaluated at least every
seven (7) days by the service recipient's treatment team. Any use of
restrictive mechanical ambulatory devices must be reviewed by the Medical
Director or designee every 24
hours.
(9) PRN: An order which is written to allow a
medication or treatment to be given on an as-needed basis.
(10) Seclusion: See Isolation.
(11) Service Recipient: For purposes of this
chapter, an individual receiving inpatient mental health services in a
hospital.
