Or. Admin. Code § 309-112-0015

Current through Register Vol. 63, No. 12, December 1, 2024

Section 309-112-0015 - Use of Restraint in Emergencies

(1) Subject to the provisions of these rules, restraint may be used to manage the behavior of a patient in emergencies. An emergency exists, as determined by the chief medical officer or designee if, because of the behavior of a patient:

(a) There is a substantial likelihood of immediate physical harm to the patient or others in the institution; or

(b) The patient's behavior seriously disrupts the activities of other patients on the unit or cottage; or

(c) Measures other than the use of restraint are deemed ineffective to manage the behavior.

(2) When an emergency exists:

(a) The staff of a state institution shall select the most appropriate intervention consistent with OAR 309-112-0010(9);

(b) Whenever the interdisciplinary team (IDT) has reason to believe that in the course of a patient's care, custody, or treatment at a state institution it may become necessary to use restraint in an emergency, a member of the IDT shall, if practicable, ask the patient for an expression of preference or aversion to the various forms of intervention. A member of the IDT shall also ask the parent or guardian for an expression of preference regarding forms of intervention. The patient's expression, if any, as well as that of the parent or guardian shall be relayed to the other IDT members and recorded in the patient's chart;

(c) The patient's wishes for or against particular forms of intervention shall be respected by the person authorizing the use of restraint, provided that primary consideration shall be given to the need to protect the patient and others in the institution.

(3) Authorization:

(a) Except as provided in subsections (3)(d) and (e) of this rule, restraint shall be administered only pursuant to the order of the chief medical officer or the chief medical officer's designee;

(b) For the purposes of this section, the chief medical officer may designate one or more of the following persons: A physician licensed to practice medicine in the State of Oregon, a psychologist, or a psychiatric/mental health nurse practitioner;

(c) The chief medical officer or designee shall order the use of restraint only after adequately assessing the patient's condition and the environmental situation;

(d) If the chief medical officer or designee is not available immediately to assess the need for intervention, and an emergency exists as defined in section (1) of this rule:

(A) The person in charge of the unit or cottage at the time:

(i) May authorize temporary use of restraint for a period of time not to exceed 30 minutes; and

(ii) Shall immediately contact the chief medical officer or his or her designee.

(B) The chief medical officer or designee shall personally observe the patient as soon as practicable to assess the patient and assess the appropriateness of the temporary use of restraint. The observation shall be documented in the person's chart.

(e) Every incident of personal restraint must be ordered by the chief medical officer or their designee, or as provided in subsection (3)(d) of this rule. The order may be oral or written but shall be documented as provided in section (4) of this rule.

(4) Documentation:

(a) No later than the end of their work shifts, the persons who authorized and carried out the use of restraint shall document in the patient's chart including but not necessarily limited to:

(A) The specific behavior which required intervention;

(B) The method of intervention used and the patient's response to the intervention; and

(C) The reason this specific intervention was used.

(b) Within 24 hours after the incident resulting in the use of restraint, the chief medical officer or designee who ordered the intervention shall review and sign the documentation. In the case of patients detained in a psychiatric hospital pursuant to an emergency hold under ORS 426.180 through 426.225, the treating physician shall sign the documentation, if the treating physician is not the chief medical officer or designee who ordered the intervention.

(5) Time Limits: All orders authorizing use of restraint shall contain an expiration time, not to exceed 12 hours and consistent with OAR 309-112-0010(8). Upon personal re-examination of the patient, the chief medical officer or designee may extend the order for up to 12 hours at each review, provided that the behavior of the patient justifies extended intervention. After each 24 hours of continuous restraint, a second opinion from another designee of the chief medical officer shall be required for further extension of the restraint.

(6) Reporting: Under this rule all emergency uses of restraint in excess of 15 minutes shall be reported daily to the chief medical officer or designee.

(7) After the second use of emergency restraint on a particular patient during a one-month period, a treatment program designed to reduce the need for restraint must be developed.

Or. Admin. Code § 309-112-0015

MHD 1-1982(Temp), f. & ef. 1-14-82; MHD 7-1982, f. & ef. 3-29-82; MHD 22-1982(Temp), f. & ef. 9-24-82; Reverted to MHD 7-1982, f. & ef. 3-29-82; MHD 1-1984, f. 1-20-84, ef. 2-1-84; MHD 2-1986, f. & ef. 3-31-86; MHS 2-2013(Temp), f. & cert. ef. 1-23-13 thru 7-19-13; Reverted to MHD 2-1986, f. & ef. 3-31-86; MHS 6-2015(Temp), f. 10-20-15, cert. ef. 10-21-15 thru 4-15-16; Reverted to MHD 2-1986, f. & ef. 3-31-86; MHS 2-2016, f. & cert. ef. 4/21/2016; BHS 11-2020, amend filed 09/22/2020, effective 9/23/2020; BHS 6-2022, temporary amend filed 04/12/2022, effective 4/12/2022 through 10/8/2022; BHS 16-2022, amend filed 08/11/2022, effective 8/11/2022

Statutory/Other Authority: ORS 179.040 & 413.042

Statutes/Other Implemented: ORS 426.385