P.R. Laws tit. 24, § 6155d
Seclusion shall only be employed as a therapeutic measure to keep the adult from inflicting harm upon him or herself or others or from damaging property. Its use shall be circumscribed to hospital institutions and mental healthcare centers that have acute care wards. Under no circumstance shall seclusion be used as punishment, as a disciplinary measure, or for the convenience of the personnel of the institution.
Seclusion shall only be employed when there is a written order issued by a psychiatrist to that effect, who after having observed the adult, is clinically convinced that the employment of seclusion is the indicated alternative. The examination shall include an evaluation of the mental state and the physical condition of the adult.
In case of emergencies that require the immediate use of this measure, when the psychiatrist is not available, seclusion may be temporarily instituted by a physician or registered nurse, or a member of the inter- or multidisciplinary team duly trained and certified on this modality, who after consulting a psychiatrist by phone and having personally observed the patient, is clinically convinced that instituting seclusion is indicated in order to keep the adult from inflicting harm upon him or herself or others or from damaging property. Once the psychiatrist is available, he/she shall conduct an evaluation to enter the written order in the clinical record as soon as practicable, but by no means shall it be after twelve (12) hours from instituting the emergency seclusion.
The seclusion order shall be entered in the clinical record, which shall also include the reasons for which it was issued, and the closest family member or legal guardian shall be notified of the use of seclusion as soon as practicable. The order shall also include the duration of such seclusion and the aspects to be observed. A seclusion order shall be valid for twelve (12) hours. Each seclusion period shall require that the psychiatrist issue a new order after having conducted a direct evaluation of the person. The psychiatrist who orders seclusion shall immediately notify its use in writing to the institution’s director and the inter- or multidisciplinary team.
Seclusion shall be used during a period of not more than eight (8) hours, counted as of the time of its institution. Once seclusion has been used over said period, it shall not be used again on the same adult for the following two (2) calendar days. The provisions of this section shall be subject to the regulations and licensing requirements for institutional providers of mental healthcare services that the Administration shall promulgate for these purposes.
The psychiatrist who orders seclusion shall designate a registered nurse trained and certified on this modality to observe the adult, at least every fifteen (15) minutes, without infringing upon the patient’s right to privacy, and to enter his/her observations in the clinical record in a legible, clear and precise manner.
Seclusion rooms shall be duly prepared pursuant to the federal and Commonwealth protocols in effect in order to keep the adult from harm.
It shall be mandatory to conduct, as soon as practicable, a review of the use of therapeutic seclusion, to be recorded in the form of minutes by the medical faculty and the medical director stating the reasons that support the use of this modality in order to establish the professional accountability of team members.
The director of the hospital institution shall notify or review all seclusion orders on a daily basis and render a yearly report to the Administration.
The institution shall establish in writing a protocol for therapeutic seclusion pursuant to the provisions contained in this section.
History —Oct. 2, 2000, No. 408, § 4.05; Aug. 6, 2008, No. 183, § 26.