Section 0940-03-09-.18 - TRAINING(1) The mental health residential treatment facility must identify specific staff, based on their job responsibilities, who may be involved in the use of isolation, mechanical restraint, or physical holding restraint. Staff must be appropriately trained and demonstrate competency in the correct application and safe usage of isolation, mechanical restraint, and physical holding restraint. Only trained staff who are qualified by education, training, and experience may train others. Staff training must include training exercises in which staff members successfully demonstrate in practice the techniques they have learned for managing emergency safety situations. Staff must be trained and demonstrate competency before assuming direct care responsibilities that include the use of isolation, mechanical restraint, or physical holding restraint. The mental health residential treatment facility must assure that staff are trained and competent in the following areas:(a) Upon being hired and every six (6) months thereafter:1. Specific techniques approved by the mental health residential treatment facility for the safe and appropriate application and removal of isolation, mechanical restraint, and physical holding restraint;2. Use of non-physical intervention skills, such as de-escalation, mediation, conflict resolution, active listening, and verbal and observational methods, to prevent emergency safety situations;3. Recognition of negative effects of use of isolation, mechanical restraint, and physical holding restraint, including signs of distress, and actions to take if negative effects or signs of distress occur;4. Techniques to identify staff and service recipient behaviors, events, and environmental factors that may trigger emergency safety situations;5. Use of devices, materials, and/or equipment approved by the mental health residential treatment facility as mechanical restraints; and6. Procedures for conducting a comprehensive service recipient review and episode review as required in section 0940-3-9-.16.(b) Upon being hired and annually thereafter:1. Medical/physical and psychological risks associated with the use of isolation, mechanical restraint, and physical holding restraint;2. Mental health residential treatment facility policies and procedures regarding isolation, mechanical restraint, and physical holding restraint;3. Needs and behaviors of the population served;4. Liability and other legal issues;5. Applicable state and federal law and rules; and6. Procedures to address problems associated with the use of isolation, mechanical restraint, or physical holding restraint.(2) If diploma, associate, or baccalaureate prepared registered nurses are responsible for the assessment of the service recipient's condition within one hour (1) hour of the initiation of isolation, mechanical restraint, or physical holding restraint, the mental health residential treatment facility must identify specific registered nurses with this responsibility and must assure that they are adequately trained and are competent in the following areas:(a) Anticipation of adverse medical/physical and psychological service recipient response(s) which had been identified in the risk assessments required in 0940-3-9-.10;(b) Anticipation of adverse medical/physical and psychological response(s) based upon the current condition of the service recipient;(c) Identification and management of adverse medical/physical and psychological response(s) resulting from the use of isolation, mechanical restraint, or physical holding restraint; and(d) Identification and utilization of the service recipient's mental preparedness to self regulate and objectively appraise the isolation, mechanical restraint, or physical holding restraint event.Tenn. Comp. R. & Regs. 0940-03-09-.18
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. §§483.376.