Section 260.217 - Restraints(a) A restraint is a restrictive intervention that a program provider may use in accordance with this section.(b) A program provider providing licensed assisted living must comply with § 553.267(a)(3)(A) and (D) of this title (relating to Rights).(c) A program provider must ensure that a six-bed ICF/IID providing respite complies with § 551.42(e)(4) of this title (relating to Standards for a Facility).(d) A program provider providing licensed home health assisted living:(1) must not use restraints:(A) for disciplinary purposes, retaliation, coercion, or retribution;(B) for the convenience of a service provider or other persons; or(C) as a substitute for an effective, less restrictive method;(2) may use a restraint only: (A) if the use is authorized, in writing, by a physician and specifies:(i) the circumstances under which the restraint may be used; and(ii) the duration for which the restraint may be used; or(B) if the use is necessary in a behavioral emergency to protect an individual or others from injury;(3) except in a behavioral emergency, must ensure:(A) that a service provider who uses a restraint has been trained in the use of the restraint:(i) before using the restraint;(iii) when the individual's needs change; and(B) that the training is documented in the service provider's record;(4) must not use a restraint under any circumstance if it:(A) obstructs the individual's airway, including a procedure that places anything in, on, or over the individual's mouth or nose;(B) impairs the individual's breathing by putting pressure on the individual's torso;(C) interferes with the individual's ability to communicate; or(D) places the individual in a prone or supine position;(5) must ensure that if a physical restraint is used in a behavioral emergency: (A) it must be a restraint in which the individual's limbs are held close to the body to limit or prevent movement and that does not violate the provisions of paragraph (4) of this subsection;(B) that as soon as possible but no later than one hour after the use of the restraint, the service provider notifies an RN of the restraint;(C) that after the RN is notified of the use of the restraint, the service provider documents the RN's instructions to the service provider;(D) that medical services are obtained for the individual as necessary;(E) the program provider: (i) with the individual's consent, makes an appointment with a physician no later than the end of the first business day after the use of restraint and document in the individual's record that the appointment was made; or(ii) if the individual refuses to see a physician, documents the refusal in the individual's record; and(F) that as soon as possible but no later than 24 hours after the use of restraint, the program provider notifies one of the following persons, if there is such a person, that the individual has been restrained:(i) the individual's LAR; or(ii) an actively involved person with the individual's care, unless the release of this information would violate other law;(6) that uses a restraint must document in an individual's record:(A) the use of the restraint;(B) time and date the restraint was used;(C) name of person administering the restraint;(D) type of restraint and duration used; and(E) if used in a behavioral emergency:(i) events preceding the use of the restraint;(ii) actions taken after the use of the restraint; and(iii) types of intervention attempted before the use of the restraint; and(7) in order to decrease the frequency of the use of restraint, and to minimize the risk of harm to an individual, must ensure that a service provider is aware of and adheres to the findings of the nursing assessment required in § 260.61(c)(8) of this chapter (relating to Process for Enrollment of an Individual) or in § 260.77(b)(1)(B) of this chapter (relating to Renewal and Revision of an IPP and IPC) for each individual.26 Tex. Admin. Code § 260.217
Adopted by Texas Register, Volume 48, Number 07, February 17, 2023, TexReg 0913, eff. 2/26/2023