Section DHS 40.08 - Emergency safety interventions(1) PROHIBITED INTERVENTIONS. Mechanical restraints, with the exception of procedures in sub. (5) (e) and chemical restraints are prohibited.(2) GENERAL REQUIREMENTS FOR SECLUSION AND PHYSICAL RESTRAINT. Seclusion and physical restraint shall comply with the requirements under s. 51.61 (1) (i), Stats., s. DHS 94.10, and this chapter.(3) STAFF REQUIREMENTS. Seclusion and physical restraint shall only be administered by program staff members who have completed orientation described in s. DHS 40.10 (6) (b).(4) ADMINISTRATION REQUIREMENTS. Seclusion and physical restraint may only be administered when all of the following requirements are met in addition to the requirements under s. 51.61 (1) (i), Stats., and s. DHS 94.10: (a) When all other less restrictive methods have been exhausted.(b) For the shortest time possible and only until the youth is no longer a danger to self or others.(c) In a manner that is attentive to, and respectful of the trauma history, dignity, and civil rights of the youth.(d) To avoid or cause the least possible physical or emotional discomfort, harm, and pain to the youth.(e) Allowing adequate access to bathroom facilities, drinking water, and necessary medication.(5) SPECIFIC REQUIREMENTS FOR SECLUSION.(a) Program staff members shall provide uninterrupted supervision and monitoring of the youth and entire seclusion area during seclusion by being in the room with the youth or by observation through a window into the room.(b) A program shall maintain an incident log to document the use of seclusion. The log shall include the time when the seclusion began, the youth's behaviors and staff member's response to those behaviors every 5 minutes, and the time seclusion ended.(c) Seclusion rooms shall be free of objects or fixtures with which the youth could inflict bodily harm.(d) Only a single youth may be placed in a seclusion room.(e) A youth may only be kept in the seclusion area by means of one of the following: 1. A staff member is in a position, such as in a doorway, to prevent a youth from leaving the seclusion area.2. A staff member physically holds a door shut to a seclusion room.3. A door to a seclusion room is latched by positive pressure applied by a staff member's hand without which the latch would spring back allowing the door to open on its own accord, except that a hospital-based program may use a magnetic door lock or a lock which requires the turn of a knob to unlock a door. Other designs of door locks shall not be used, including padlock, key lock, or other locks of similar design.(6) SPECIFIC REQUIREMENTS FOR PHYSICAL RESTRAINT.(a) Physical restraint shall only be administered to a youth during an emergency, when there is a serious threat of violence to other youth or a staff member, personal injury, or attempted suicide.(b) At a minimum, two staff members trained in the use of emergency safety interventions shall be physically present during the administration of physical restraint, and shall continually monitor the condition of the youth and the safe use of physical restraint throughout the duration of the intervention.(c) Methods of physical restraint that are likely to cause bodily harm are prohibited, such as: 1. Pressure or weight on the chest, lungs, sternum, diaphragm, back, or abdomen, such as straddling or sitting on the torso.2. Pressure, weight, or leverage on the neck or throat, on any artery, or on the back of the head or neck, or that otherwise obstructs or restricts the circulation of blood or obstructs an airway, such as choke holds or sleeper holds.3. Wrestling holds or martial arts techniques.4. Covering the face with any object, such as a pillow, towel, washcloth, blanket, or other fabric.5. Pain or pressure points.6. Hyperextension of limbs, fingers, or neck.7. Forcible take downs from a standing position to the floor.8. Restraint in a prone position.9. Restraint in a supine position.10. Restraint in a vertical position, with upper body pressed against a wall or hard surface.11. Any other physical restraint that is not administered during an emergency, that is administered for longer than necessary to prevent immediate injury to a youth or others, or that is administered for a purpose other than to prevent immediate injury to a youth or others.(d) Immediately upon the termination of a physical restraint, a medical staff member, such as a physician, advanced practice nurse prescriber, physician assistant, advanced practice nurse, or registered nurse, shall conduct a follow-up assessment of the condition of the youth to ensure that the youth was not injured and shall document the finding of the assessment in the youth's file. If a staff member who is a doctor or nurse is not present on site, a licensed treatment professional shall conduct the face-to-face assessment immediately upon termination of the physical restraint and notify a medical staff member.(e) If any injury is noted following a physical restraint, a staff member shall notify the youth's legal representative, if any, and make a referral for medical care.(7) DEBRIEFING. (a) Following a seclusion or restraint, a staff member shall talk with the youth about each of the following: 1. The circumstances that contributed to the seclusion or physical restraint and what could have been handled differently by the staff member.2. The youth's psychological well-being and the emotional impact of the intervention.3. What modifications can be made in the youth's services or treatment plan to prevent future seclusion and physical restraint.(b) The debriefing should occur within 24 hours following a seclusion and restraint, with the following exceptions: 1. When clinically contraindicated.2. When the 24 hour period falls during non-programming time such as on a weekend or holiday, then debriefing shall occur on the next programming day.3. When a youth is suspended or discharged from programming following the incident and debriefing is contraindicated due to a serious risk of harm by the youth to others or to staff.(c) A program shall notify a youth's legal representative, if any, of any seclusion or physical restraint on the same day that it was administered to the youth. The program shall document in the youth's file any situation in which notification has been attempted and the program has been unable to contact the legal representative.(d) Each administration of seclusion or physical restraint shall be documented in the youth's chart and shall specify all of the following: 1. Less restrictive interventions attempted prior to the seclusion or physical restraint.2. Events precipitating the seclusion or physical restraint.3. Length of time the seclusion or physical restraint was used.4. Assessment of the appropriateness of the seclusion or physical restraint based on threat of harm to self or others.5. Assessment of any physical injury to the youth, other clients, or to staff members.6. The youth's response to the emergency safety intervention.(e) A licensed treatment professional shall review all seclusion and physical restraint documentation prior to the end of the shift in which the intervention occurred and determine whether changes to the youth's safety plan or treatment plan are necessary.(f) If seclusion or physical restraint is administered to a youth more than three times over a period of five days, or in a single instance for more than 30 minutes within 24 hours, the clinical coordinator, or designee, shall do all of the following: 1. Convene staff to discuss the emergency situation that required seclusion or physical restraint, including the precipitating factors that led up to the intervention and any alternative strategies that might have prevented the use of seclusion or physical restraint in those situations.2. Convene staff to discuss the procedures, if any, to be implemented to prevent further administration of seclusion or physical restraint.3. Convene staff to discuss the outcome of the seclusion or physical restraint including any injuries.4. Convene the youth's interdisciplinary treatment team to review the individualized treatment plan and make any necessary revisions to reduce the need for and likelihood of further use of seclusion or physical restraint, and document the discussion and any resulting changes to the plan in the youth's chart.5. Determine whether a higher level of care is required for the youth and if a referral for inpatient or residential placement is necessary.(8) REPORTING. (a) Programs shall report all incidences of seclusion, physical restraint, injury, and involvement of law enforcement to the department within 24 hours of the incident occurring. Reporting shall be completed through the department's online reporting system.(b) The department will evaluate the circumstances of each incident, conduct any appropriate follow-up, and identify programs in need of technical assistance, training, policy development, or other quality improvement.Wis. Admin. Code Department of Health Services § DHS 40.08
Cr. Register, August, 1996, No. 488, eff. 9-1-96.Adopted by, CR 19-018: cr. Register June 2020 No. 774, eff. 7-1-20; correction in (4) (intro.), (5) (e) 3., (6) (d), (7) (e) made under s. 35.17, Stats., Register June 2020 No. 774, eff. 7/1/2020Amended by, CR 23-053: am. (7) (a) (intro.) Register September 2023 No. 813, eff. 10/1/2023