Tenn. Comp. R. & Regs. 0940-03-09-.12 - MONITORING AND ASSESSMENT OF CONTINUED NEED

(1) To continue the use of isolation, mechanical restraint, or physical holding restraint, there must be ongoing assessment of need that justifies the continued use. To continue use, the justification must indicate that the behavioral criteria for release have not been met. All results of monitoring must be documented in the service recipient's record. Use of isolation, mechanical restraint, or physical holding restraint must be monitored as outlined below.

(a) Isolation: Staff trained in monitoring isolation must monitor a service recipient in isolation. The service recipient must be continuously monitored. Monitoring must be by direct visual observation.

(b) Mechanical Restraint: Staff trained in the monitoring of mechanical restraint must monitor a service recipient in mechanical restraint. The service recipient must be continuously monitored. Monitoring must be by direct visual observation and staff must remain in the immediate physical presence of and in the same room as the service recipient.

(c) Physical Holding Restraint: Staff trained in the monitoring of physical holding restraint must monitor a service recipient in a physical holding restraint. The service recipient must be continuously monitored. A staff member who is trained in the monitoring of physical holding restraints must be present as an observer at all times while a service recipient is in a physical holding restraint.

(d) At intervals no greater than fifteen (15) minutes, staff must document visual observations of:

1. behavior justifying continued need for isolation, mechanical restraint, or physical holding restraint;

2. if applicable, the application of the mechanical restraint or physical holding restraint;

3. respiration;

4. negative effects of isolation, mechanical restraint, or physical holding restraint;

5. any sign of distress; and

6. if applicable, an evaluation of the fatigue of the staff member employing a physical holding restraint.

(e) At intervals no greater than one (1) hour for isolation, mechanical restraint or physical holding restraint, the service recipient must be allowed to toilet and be offered fluids. For mechanical and physical holding restraint, the service recipient must also be checked for range of motion. Nourishment must be offered at routine meal and snack times. The facility must document the requirements of 0940-3-8-.12(e) in the service recipient's record.

(f) At intervals no greater than thirty (30) minutes for physical holding restraint, or one hour for isolation or mechanical restraint, staff who may initiate isolation, mechanical restraint, or physical holding restraint must document an assessment of continued need for isolation, mechanical restraint, or physical holding restraint.

(g) A service recipient must be released from isolation, mechanical restraint, or physical holding restraint when the need for the intervention no longer exists. Before the shift ends, a staff member who may initiate isolation, mechanical restraint, or physical holding restraint must document in the service recipient's record an assessment of the service recipient's behavior, mental and physical status at the time the service recipient is released, the time the isolation, mechanical restraint, or physical holding restraint began and ended, and the name of all staff involved.

Notes

Tenn. Comp. R. & Regs. 0940-03-09-.12

Original rule filed March 3, 2008; effective May 17, 2008.

Authority: T.C.A. §§ 4-4-103, 4-5-202 and 204, 33-1-302, 305, 309, and 33-3-120; 42 C.F.R. §§483.358(h), 483.362, and 483.364.