Section He-M 305.04 - Seclusion or Restraint(a) An emergency response may include use of restraint or seclusion.(b) Restraint or seclusion shall: (1) Not be imposed longer than is necessary to resolve a personal safety emergency regardless of the length of the time identified in the order;(2) Not exceed 15 minutes unless there is documented authorization by a physician; and(3) Only be used with a child according to the requirements of RSA 126-U:5, and RSA 126-U:5-a, 5-b and shall not include techniques listed in RSA 126-U:4.(c) Before seclusion or restraint is employed, an individual who can make an informed decision to be voluntarily placed in an unlocked room shall be offered that alternative, if feasible.(d) Restraint or seclusion shall be used only as a last resort when no other intervention in an emergency situation is feasible to protect the immediate safety of the individual or others.(e) Seclusion or restraint shall never be used explicitly or implicitly as punishment for the behavior of the individual.(f) Individuals in seclusion or restraint shall be afforded privacy through practices including: (1) The use of a single room;(2) Minimizing external stimuli such as noise, nearby movement, and approaches by other individuals;(3) Continuous staff observation to assure the conditions in (2) above are met; and(4) If the individual in seclusion or restraint is a child, the conditions of seclusion shall be pursuant to RSA 126-U:5-a, RSA 126-U:5-b, and RSA 126-U:11, and shall not include the techniques listed in RSA 126-U:4.(g) Authorization for the use of seclusion or restraint shall be as follows: (1) A physician may write an order for the use of seclusion or restraint; or(2) A physician may authorize the use of seclusion or restraint via telephone when the order: a. Follows deliberate and comprehensive consultation between the physician and a trained advanced practice registered nurse (APRN) or registered nurse (RN) who has personally evaluated the individual by reviewing: 1. The assessments of the individual that have been performed;2. The safety issues involved; and3. The potential antecedents to the seclusion or restraint;b. Is for a period not to exceed one hour; andc. Is countersigned by the ordering physician within 24 hours of the time such treatment was ordered and;(3) If authorization is for the use of seclusion or restraint with a child, the authorization shall be given pursuant to a written policy consistent with RSA 126-U:2 and authorization and monitoring pursuant to RSA 126-U:11.(h) A physician may authorize in writing, on the physician order sheet, or verbally, by telephone, the extension of an order of seclusion or restraint if he or she, or a trained APRN or RN, has personally examined, observed, and assessed the individual for whom the seclusion or restraint is ordered.(i) Following an examination and assessment as required by (g) above, a physician may issue an order to extend seclusion or restraint if the order is for: (1) Not more than 4 hours if the individual is at least 18 years old;(2) Not more than 2 hours if the individual is at least 9 but not more than 17 years old; or(3) Not more than one hour if the individual is less than 9 years old.(j) If the individual is a child, then any order to extend seclusion or restraint in (i) above shall be subject to the limitations of RSA 126-U:11, III and IV.(k) A physician who authorizes seclusion or restraint shall, in collaboration with the attending registered nurse, establish release criteria for the termination of the seclusion or restraint.(l) If the condition of the individual does not improve to meet the criteria for termination, the physician may renew the order as specified in (h) above for up to the time limits established in (i) above, provided that no individual shall remain in seclusion or restraint for more than 24 hours from the time such procedure was initiated unless a physician personally examines, observes and assesses the individual and renews the order in writing.(m) Nursing staff trained pursuant to He-M 305.07 shall continually monitor the individual during periods of seclusion or restraint to ensure that: (1) In the judgment of the nursing staff, all reasonable measures are in place to ensure that the individual's health and safety is protected during the period of seclusion or restraint;(2) The individual receives meals and regular opportunities to move and to utilize the bathroom;(3) All other basic physiological needs are identified and met; and(4) The seclusion or restraint is discontinued as soon as the emergency is resolved, regardless of the length of time identified in the order.(n) Individuals in seclusion or restraint shall have the right to: (1) Wear their own clothes, unless clinically contraindicated; and(2) Meet with an attorney.(o) No procedure or device for seclusion or restraint shall be utilized without the authorization of the clinical managers of the facility.N.H. Admin. Code § He-M 305.04
#3095, eff 8-19-85; EXPIRED: 8-19-93
New. #5204, eff 8-22-91, EXPIRED: 8-22-97
New. #7183, eff 12-24-99, EXPIRED: 12-24-07
New. #9120, eff 4-3-08
Amended by Volume XXXVI Number 23, Filed June 9, 2016, Proposed by #11102, Effective 5/25/2016, Expires 11/21/2016.Amended by Volume XXXVII Number 2, Filed January 12, 2017, Proposed by #12077, Effective 12/28/2016, Expires 12/28/2026.