S.C. Code Regs. § § 61-103.E

Current through Register Vol. 48, 12, December 27, 2024

Section 61-103.E - Problem Management

The facility must have current written policies and procedures for using seclusion or any form of restraint. Seclusion or other forms of restraint must not be used for staff convenience or as a substitute for treatment. (I)

(1) Restraining Measures: All staff working directly with residents must be trained in crisis management and the appropriate use of restraining measures. No staff may use personal restraint or apply protective devices or mechanical restraints unless trained to perform these procedures safely. The training must be documented in the staff's records. (I)

(2) Protective Devices: Protective devices may be used to prevent a resident from injuring or mutilating himself or others. A physician must give signed written authorization for their use. (I)

(a) Use of protective devices must be documented in the resident's record.

(b) Use of protective devices must be evaluated as part of the regular review of the treatment plan.

(3) Mechanical Restraint: (I)

(a) Mechanical restraint may be used only with a physician's signed written authorization to prevent the resident from injuring himself or others. Verbal authorization must be noted. The physician must review and sign the verbal authorization within 24 hours.

(b) The physician's instructions, including verbal instructions, must be followed and must include:

(1) the reason for use of mechanical restraint;

(2) the type of restraint that may be used;

(3) the maximum time the restraint may be used;

(4) instructions for observing the resident while in restraint if different from the facility's written procedures.

(c) Residents placed in mechanical restraint must be:

(1) checked for adequate circulation and comfortable position at least every 15 minutes;

(2) given medications as prescribed, unless otherwise ordered by the physician;

(3) given an opportunity for motion and exercise for no less than 5 minutes during each two hours the resident is in mechanical restraint;

(4) given bathroom privileges at least every 2 hours;

(5) offered fluids at least every 2 hours;

(6) given the opportunity for nourishment if desired, or at regularly scheduled meal times.

(d) The use of mechanical restraint must be documented in the resident's record. Documentation must include the date and time implemented, length of time restrained, specific behaviors necessitating restraint, pertinent observations while resident is restrained, checking of the resident for adequate circulation and comfortable position and the offering, provision, or refusal of range of motion, bathroom privileges, fluids and nourishment.

(e) The use of mechanical restraint must be evaluated as part of the next treatment plan review. Program staff must consider alternative strategies to handle the behavior that necessitated the use of mechanical restraint. Consideration must be documented in the resident's record. If mechanical restraints are needed more than 24 hours the resident must be transferred to a facility capable of providing proper care.

(4) Seclusion: (I)

(a) Seclusion may be used only with a physician's signed written authorization. Verbal authorization must be noted. Verbal authorization must be reviewed and signed within 24 hours.

(b) The physician's instructions, including verbal instructions, must be followed. They must include:

(1) the reason for seclusion;

(2) the maximum time seclusion may be used;

(3) instructions for observing the resident while in seclusion, if different from the facility's written procedures.

(c) If a resident is in seclusion for as long as 24 hours, the physician must see the resident, determine the need for continued seclusion, and sign the written instructions each 24 hours.

(d) If the resident's behavior is self-destructive while in seclusion, staff must intervene.

(e) Resident placed in seclusion must be:

(1) checked at least every 15 minutes;

(2) given regularly prescribed medications, unless otherwise ordered by the physician;

(3) given bathroom privileges at least every 2 hours;

(4) offered fluids at least every 2 hours;

(5) given the opportunity for nourishment if desired or at regularly scheduled meal times.

(f) A room used for seclusion must have at least 40 square feet of floor space and be free of safety hazards, adequately ventilated during warm weather, adequately heated during cold weather and appropriately lighted. All parts of the room must be clearly visible from the outside.

(g) All items or articles that a resident might use to injure himself must be removed from a room used for seclusion.

(h) At least a mat and bedding must be provided in the seclusion room except when a physician's orders are to the contrary.

(i) The use of seclusion must be documented in the resident's record. Documentation must include the date and time the resident was secluded, the length of seclusion, and the name of the staff requesting seclusion; the specific behaviors that necessitated using seclusion; observations of the resident while in seclusion, including the time of observation and the resident's behavior; any injury the resident sustained as a result of the incident or the use of seclusion, and the offering, provision or refusal of fluids, nourishment, and bathroom privileges.

(j) The use of seclusion must be evaluated as part of the next treatment plan review. Program staff must consider alternative strategies to handle the behavior that necessitated using seclusion. Consideration must be documented in the resident's record.

(5) Discharge Planning: (II)

(a) Discharge. Discharge planning begins at the time of admission. A discharge date shall be projected in the treatment plan. Discharge orders shall be signed by a physician. A discharge summary shall be included in the records. Discharge planning shall include input from the multidiscipline staff.

(b) There must be a written plan for follow-up services, either by the facility or by another agency.

(c) Arrangements for alternative and more appropriate placement must be made prior to the 18th birthday of any resident who needs continued treatment.

S.C. Code Regs. § 61-103.E