(a) A center may use restraint or seclusion only if

1. (1) restraint or seclusion is ordered by a physician or other licensed practitioner who

   1. (A) is responsible for the patient's care; and
   2. (B) meets the training requirements established by the center;
2. (2) restraint or seclusion is necessary for the immediate physical safety of the patient, a staff member, or another patient;
3. (3) less restrictive interventions have been attempted or have been determined to be ineffective;
4. (4) the center uses the restraint or seclusion in a manner that complies with patient rights established in 7 AAC 12.391;
5. (5) the restraint or seclusion type or technique is the least restrictive intervention that will be effective;
6. (6) the restraint or seclusion is imposed and monitored by staff who meet the training requirements in this section;
7. (7) the restraint or seclusion is documented in accordance with the requirements of this section;
8. (8) the restraint or seclusion is implemented in accordance with safe and appropriate techniques as set out in center policy; and
9. (9) the restraint or seclusion is discontinued at the earliest possible time.

(b) A restraint does not include a

1. (1) medical device, including

   1. (A) an orthopedically prescribed device;
   2. (B) a surgical dressing or bandage;
   3. (C) a protective helmet; or

   4. (D) another device or method used to

      1. (i) permit the patient to participate in activities without the risk of physical harm; or
      2. (ii) protect the patient from falling out of a bed or chair; or
2. (2) technique that involves physically holding a patient for the purpose of conducting routine physical examinations or tests.

(c) An order for restraint or seclusion

1. (1) may not be written

   1. (A) as a standing order; or
   2. (B) for an as-needed basis;

2. (2) may be renewed only in accordance with the following limits for up to a total of 24 hours:

   1. (A) four hours for an adult 18 years of age or older;
   2. (B) two hours for a child or adolescent at least nine years of age and under 18 years of age;
   3. (C) one hour for a child under nine years of age; and
3. (3) may be renewed only if the physician or other licensed practitioner who is responsible for the patient's care and authorized by center policy to order restraint or seclusion performs an in-person assessment of the patient before renewing an order for restraint or seclusion to manage violent or self-destructive behavior.

(d) A patient who is placed in restraint or seclusion shall be

1. (1) given adequate hydration, food, and access to bathroom facilities;
2. (2) monitored continuously by a staff member; the staff member shall document the patient's condition at least every 15 minutes; and

3. (3) monitored at least hourly by a physician, other licensed practitioner, or trained staff who meets the training requirements established by the center and who evaluates the

   1. (A) patient's immediate situation;
   2. (B) patient's reaction or response to the intervention;
   3. (C) patient's medical and behavioral condition; and
   4. (D) need to continue or terminate the restraint or seclusion.

(e) A center shall notify the legal guardian of an adult patient, if applicable, or the parent or legal guardian of a minor placed in a restraint or seclusion intervention not more than 24 hours after the termination of the restraint or seclusion. The center shall include in the notification of restraint or seclusion

1. (1) the reason for the use of restraint or seclusion;
2. (2) the type or method of restraint or seclusion used;
3. (3) medication administered during the use of restraint or seclusion;
4. (4) the length of time the restraint or seclusion was used;
5. (5) a nurse or physician medical and behavioral evaluation of the patient following the termination of restraint or seclusion; and
6. (6) a description of any injury sustained while restraint or seclusion was used.

(f) A center shall document each use of restraint or seclusion. Documentation of each use of restraint or seclusion must include

1. (1) the physician's or other licensed practitioner's order to use restraint or seclusion;
2. (2) the documentation of continuous monitoring;
3. (3) a description of the patient's behavior, conditions, or symptoms that warranted the use of restraint or seclusion;
4. (4) the type of restraint or seclusion used;
5. (5) the less restrictive interventions attempted;
6. (6) the use of any pharmacological intervention, including the name of the medication, dose, and route and time of delivery;
7. (7) the patient's response to pharmacological intervention;
8. (8) the rationale for renewal orders, if applicable;

9. (9) a patient evaluation conducted not more than one hour after the restraint or seclusion is implemented, including the

   1. (A) patient's immediate condition;
   2. (B) patient's reaction or response to the restraint or seclusion;
   3. (C) patient's medical and behavioral condition; and
   4. (D) need to continue or terminate the restraint or seclusion; and

10. (10) notification under (e) of this section, including

    1. (A) the name and credentials of the staff member who notified an adult patient's legal guardian, if applicable, or a minor's parent or guardian;
    2. (B) the name of the parent or legal guardian who was notified; and
    3. (C) the date and time the parent or legal guardian was notified.

(g) A center shall establish and implement a restraint and seclusion training plan that

1. (1) requires a staff member to successfully complete training and demonstrate competencies seclusion;

   1. (A) as part of new employee orientation for all staff;
   2. (B) annually after the initial orientation; and
   3. (C) before the staff member performs any action related to restraint or seclusion

2. (2) requires staff to demonstrate competency in

   1. (A) techniques to identify staff and patient behaviors, events, and environmental factors that may trigger circumstances that require use of restraint or seclusion;
   2. (B) the use of nonphysical and less restrictive intervention before using restraint or seclusion;
   3. (C) choosing the least restrictive intervention based on an individualized assessment of the patient's medical or behavioral status or condition;
   4. (D) the safe application and use of restraint or seclusion used in the center;

   5. (E) monitoring and assessing the physical and psychological well-being of the patient who is restrained or secluded, including

      1. (i) respiratory and circulatory status;
      2. (ii) skin integrity;
      3. (iii) vital signs;
      4. (iv) recognizing and responding to signs of physical and psychological distress;
      5. (v) clinical identification of specific behavioral changes that indicate that restraint or seclusion is no longer necessary; and
      6. (vi) any requirements established by facility policy;
   6. (F) providing care to a patient who is restrained or secluded; and
   7. (G) documenting restraint or seclusion; and
3. (3) maintains training records in each staff member's employee record.

(h) A center shall report to the department, not more than 24 hours after the death, a patient death that occurred

1. (1) while the patient was in restraint or seclusion; or
2. (2) during the 24 hours after the patient's restraint or seclusion was terminated.