1. (a)

   1. (1) The United States Children’s Health Act of 2000, Pub. L. No. 106-310, imposes procedural reporting and training requirements regarding the use of restraints and involuntary seclusion in psychiatric residential treatment facilities that provide inpatient psychiatric services for children who are under twenty-one (21) years of age.

   2. (2)

      1. (A) Satellite training by the Centers for Medicare & Medicaid Services may be accessed on the Centers for Medicare & Medicaid Services website at www.cms.gov.
      2. (B) Federal regulations are located at 42 C.F.R. pt. 483, subpt. G (2001).
   3. (3) The use of mechanical restraints and seclusions are strictly prohibited.

2. (b) A psychiatric residential treatment facility will report monthly on an approved Office of Long-Term Care template, to the state-designated protection and advocacy system, the office, and the resident’s PASSE, or the resident’s sending state the following data:

   1. (1) Physical restraints used within the psychiatric residential treatment facility, in the aggregate and by client;
   2. (2) Chemical restraints used within the psychiatric residential treatment facility, in the aggregate and by client;
   3. (3) Sedating PRNs within the psychiatric residential treatment facility, in the aggregate and by client; and
   4. (4) Ratio of chemical restraints to sedating PRNs, in the aggregate and by client.
3. (c) An order for restraint must not be written as a standing order or on an as-needed basis.

4. (d) Restraint must not result in harm or injury to the resident and must be used only:

   1. (1) To ensure the safety of the resident or others during an emergency safety situation; and
   2. (2) Until the emergency safety situation has ceased and the resident’s safety and the safety of others can be ensured, even if the restraint order has not expired.
5. (e) Orders for restraint must be ordered by a physician or other licensed practitioner permitted by the state and the psychiatric residential treatment facility to order restraint and trained in the use of emergency safety interventions.
6. (f) If the resident’s treatment team physician is available, only he or she can order a restraint.
7. (g) A physician or other licensed practitioner permitted by the state and the psychiatric residential treatment facility to order a restraint must order the least restrictive emergency safety intervention that is most likely to be effective in resolving the emergency safety situation based on consultation with staff.

8. (h)

   1. (1) If the order for restraint is verbal, the verbal order must be received by a registered nurse or other licensed staff such as a licensed practical nurse, while the emergency safety intervention is being initiated by staff or immediately after the emergency safety situation ends.
   2. (2) The physician or other licensed practitioner permitted by the state and the psychiatric residential treatment facility to order restraint must verify the verbal order in a signed written form in the resident’s record.
   3. (3) The physician or other licensed practitioner permitted by the state and the psychiatric residential treatment facility to order restraint must be available to staff for consultation, at least by telephone, throughout the period of the emergency safety intervention.

9. (i) Each order for restraint must:

   1. (1) Be limited to no longer than the duration of the emergency safety situation; and

   2. (2) Under no circumstances exceed:

      1. (A) Four (4) hours for residents who are between eighteen (18) years of age and twenty-one (21) years of age;
      2. (B) Two (2) hours for residents who are between nine (9) years of age and seventeen (17) years of age; or
      3. (C) One (1) hour for residents who are under nine (9) years of age.

10. (j) Within one (1) hour of the initiation of the emergency safety intervention a physician, or other licensed practitioner trained in the use of emergency safety interventions and permitted by the state and the psychiatric residential treatment facility to assess the physical and psychological well-being of residents, must conduct a face-to-face assessment of the physical and psychological well-being of the resident, including but not limited to:

    1. (1) The resident’s physical and psychological status;
    2. (2) The resident’s behavior;
    3. (3) The appropriateness of the intervention measures; and
    4. (4) Any complications resulting from the intervention.

11. (k) Emergency safety intervention. An emergency safety intervention must be performed in a manner that is safe and proportionate and that is appropriate to the severity of the behavior and to the resident’s:

    1. (1) Chronological and developmental age;
    2. (2) Size;
    3. (3) Gender;
    4. (4) Physical, medical, and psychiatric condition; and
    5. (5) Personal history (including any history of physical or sexual abuse).

12. (l)

    1. (1) Staff must document the intervention in the resident’s record.
    2. (2) That documentation must be completed by the end of the shift in which the intervention occurs.
    3. (3) If the intervention does not end during the shift in which it began, documentation must be completed during the shift in which it ends.

    4. (4) Documentation must include all of the following:

       1. (A) Each order for restraint;
       2. (B) The time the emergency safety intervention actually began and ended;
       3. (C) The time and results of the one-hour physical and psychological assessment required via face-to-face of the well-being of the resident as required above;
       4. (D) The emergency safety situation that required the resident to be restrained; and
       5. (E) The name of staff involved in the emergency safety intervention.
13. (m) The psychiatric residential treatment facility must maintain a record of each emergency safety situation, the interventions used, and their outcomes.
14. (n) The physician or other licensed practitioner permitted by the state and the psychiatric residential treatment facility to order restraint must sign the restraint order in the resident’s record as soon as possible.

Codification Notes: "PASSE" means a Provider-Led Arkansas Shared Savings Entity.