N.J. Admin. Code § 10:42-3.3

Current through Register Vol. 56, No. 23, December 2, 2024

Section 10:42-3.3 - Implementation standard: developmental centers and private licensed facilities for persons with developmental disabilities licensed pursuant to N.J.A.C. 10:47

(a) Following approval by the Behavior Policy Review Committee, for use of mechanical restraints, the following standards shall apply:

1. The IDT shall review the client record to identify potential areas of increased risk in the application of mechanical restraints for the individual due to medical conditions, mental health status, physical functioning, or other personal characteristics. If potential areas of increased risk are identified, the IDT shall obtain an opinion from a physician that the technique to be employed is not medically contraindicated for the individual prior to an initial restraint authorization.

2. In an emergency situation, the authorizing personnel shall be responsible for authorizing the use of a mechanical restraint.

3. Whenever possible, the restraint order shall be immediately signed by the licensed psychologist or physician. However, the use of mechanical restraint may be authorized over the telephone by the licensed psychologist or physician in accordance with the following:

i. Such approval is strictly temporary and the restraint order shall be reviewed and signed by the licensed psychologist or physician as soon as possible but at least within 12 hours of its application; and

ii. The specific circumstances necessitating approval over the telephone shall be part of the client record and include the name of the party requesting or authorizing the restraint.

4. An emergency restraint order shall be effective for not more than one hour. If a new order is issued, all authorization shall be renewed.

5. Emergency restraint orders shall include documentation of the type of mechanical restraint authorized, the length of time to be applied, the reason for restraint, and any special instruction. Each restraint order must be signed and dated by the authorizing personnel.

6. While in mechanical restraint the individual shall be checked by a staff member every 15 minutes. The check shall document the following:

i. Whether the continued use of the restraint is necessary; and

ii. Whether the restraint is applied in accordance with principles of good body alignment, a concern for circulation and allowance for change of position.

7. The individual shall be released from restraint for a period of not less than 10 minutes during each hour of restraint. One limb may be released at a time for a 10-minute period if the person cannot be completely released.

8. The individual shall be released immediately if he or she appears to be in physical distress or the individual's behavior no longer presents a risk. In the event the individual cannot be released within 10 minutes, efforts to loosen or change the position of the restraint must be attempted. Documented attempts to release each limb separately for a 10-minute period shall be made.

9. The use of mechanical restraints, such as jumpsuits or open-faced helmets does not require 15-minute checks. The individual does not have to be removed from the restraint for a 10-minute period during each hour since it does not restrict range of motion.

10. The nature, reasons for and notation of each staff check shall be recorded in the client record.

11. If a partially enclosed bed is used as a safeguarding device, documentation of 15-minute checks shall not be required. It is not necessary to remove the individual from a partially enclosed bed for 10 minutes during each hour of use if it is used for sleeping. If a partially enclosed bed is used as a mechanical restraint, 15-minute checks shall be required.

12. The service provider shall forward a report of the unusual incident to the Regional Assistant Director.

13. Whenever a mechanical restraint is used pursuant to 10:42-2.2(a)1, a special meeting of the IDT must be held to review current programming and alternatives. If the recurrence of the behavior that required the use of the restraint may be anticipated, a behavior support plan shall be considered, and if appropriate, developed or modified to address the behavior.

14. An unusual incident report shall be completed, if the use of the restraint is unauthorized, improperly implemented, or causes injury to the individual.

15. When mechanical restraints are used for an individual three times in any contiguous six-month period and are not included in a behavior support plan, the IDT shall forward the results of their review conducted pursuant to 10:42-3.4(a)13 to a Division HRC within 15 working days.

16. A Division HRC shall review the pertinent circumstances surrounding the utilization of the emergency mechanical restraints reported by the IDT. The results of the Division HRC review shall be forwarded to the Assistant Commissioner or designee within 10 days.

N.J. Admin. Code § 10:42-3.3

Recodified from N.J.A.C 10:42-3.2 and amended by 46 N.J.R. 2149(b), effective 11/3/2014.