W. Va. Code R. § 64-59-10 - Seclusion and Restraints

10.1. General. Patients have the right to freedom from seclusion or mechanical restraints unless otherwise clinically indicated and consistent with the applicable standard of care as provided herein. Seclusion and restraint shall only be used when there is imminent danger that the patient will injure himself or herself or others and when all other less restrictive measures have been exhausted or no less restrictive measures are reasonably available. Seclusion or mechanical restraints that are used solely as a means of coercion, discipline, convenience, or retaliation are prohibited.

The use of restraint or seclusion shall only be administered in accordance with the order of a physician or psychiatrist or, in their absence, an advanced nurse practitioner or physician's assistant responsible for the care of the patient. A registered nurse who is trained in crisis intervention may initiate the emergency application of restraint or seclusion prior to obtaining such an order: Provided, That the emergency application of restraints or seclusion requires that the registered nurse obtain an order forthwith after the restraint or seclusion has been applied. Under no circumstance may orders for the use of restraint or seclusion ever be written or provided as a standing order or on an as needed basis.

10.2. Seclusion and Restraint. Seclusion of any patient or mechanical restraints for any patient, or both, may be administered only as expressly permitted by 42 C.F.R. § 482.13(e). The use, time period for use, and documentation of the use of seclusion or mechanical restraints, or both, in the patient's medical record shall be done in accordance with 42 C.F.R. § 482 and the State Operations Manual: Provided, That seclusion or mechanical restraints for developmentally disabled patients are prohibited and only the "time out" procedure developed specifically for each such patient in his or treatment plan and in accordance with applicable law may be used for a developmentally disabled patient.

All personnel at a mental health facility who administer or assists in the administration of seclusion or the use of mechanical restraints shall undergo training as required by 42 C.F.R. § 482.13(f) and shall further complete subsequent periodic training no less frequently than annually regarding the use of seclusion and or mechanical restraints.

10.3. Time. The time spent in seclusion shall be the shortest time required for the patient to regain his or her self-control.
10.4. Seclusion Inappropriate for Suicidal Patients. Seclusion shall not be used for a patient who is actively suicidal or for a patient for whom constant observation has been ordered. If the physician determines that seclusion is necessary, the need for such seclusion shall be documented in the patient's medical record and one-on-one observation of the patient shall be required.
10.5. Items Entitled During Seclusion. A patient who is placed in seclusion is entitled to clothing, a bed, a mattress, bedding, reading matter, stationery, and similar items. Only when it is determined that a specific item may be harmful to the patient may the item be withheld. The order for seclusion shall specify those items which are to be removed and the reasons for their removal.
10.6. Supervision of Seclusion Room. Any room used for seclusion shall be in an area that permits constant supervision by staff.
10.7. Seclusion Room Supervision. The registered nurse in charge of the unit or shift is responsible for assuring that the following seclusion room checks, and procedures are carried out:
10.7.1. Each patient in seclusion shall be checked no less frequently than every five minutes and as required by 42 C.F.R. § 482.13. The seclusion room "check sheet" shall be updated to assure the presence and safety of the patient in the seclusion room;
10.7.2. The patient shall have access to fluids and to the toilet hourly. Meals shall be delivered at regular meal times. Compliance with these requirements shall be documented on the check sheet; and
10.7.3. The case manager, when available, or the registered nurse in charge of the unit or shift shall talk directly with the secluded patient and assess the need for continued seclusion at least once every hour.
10.8. Supervision of Mechanical Restraints. Supervision of patients in mechanical restraints shall be on a one-to-one basis for the duration of the time the restraints are in place. The procedure for the application of mechanical restraints shall be followed to assure that no restraint is applied in a manner as to produce physical pain or damage to the patient. Opportunity for motion and exercise shall be provided for a period of not less than 10 minutes during each two hours in which restraint is employed.
10.9. Handcuffs Unacceptable. Handcuffs are not considered an acceptable form of restraint for patients and shall not be used for that purpose.
10.10. Continued Hourly Assessment. The case manager, when available, or the registered nurse in charge of the unit or shift shall talk directly with the restrained patient and assess the need for continued restraint at least once every hour.
10.11. Punishment or Convenience. Mechanical Restraints shall not be used as punishment or for the convenience of staff.
10.12. Limitation on Use of Chemical Restraint. Drugs or medications shall not be used as punishment, for the convenience of staff, as a substitute for adequate staffing, or as a substitute for a treatment plan. Drugs and medication may only be administered pursuant to informed consent in the absence of a psychiatric emergency.
10.13. Copies. All documentation related to the seclusion or restraint of a patient shall be done in accordance with the applicable standard of care, 42 C.F.R. § 482.13, and the State Operations Manual.
10.14. Trial Release Procedure for Seclusion and Restraint. Seclusion and restraint are intended to provide external controls for the protection of the patient or to prevent the patient from injuring others. Continued use of the controls beyond the time when they are clinically indicated is inappropriate. It is the responsibility of the nurse on duty to assure that the seclusion or restraint measures are stopped when the behavior of the patient makes their continued use unnecessary and to further inform the ordering physician promptly of events that support the cessation of seclusion or restraints.


W. Va. Code R. § 64-59-10

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