1. A. Physical restraints may be used only:

   1. (1) As an integral part of an individual medical treatment plan;
   2. (2) If absolutely necessary to protect the resident or others from injury;
   3. (3) If prescribed by a physician or administered by another health care professional practicing within the scope of their license; and
   4. (4) If less restrictive alternatives were considered and appropriately ruled out by the physician.

2. B. Use of Physical Restraints.

   1. (1) When a facility uses physical restraints, personnel:

      1. (a) Trained in the use of restraints shall check a resident in restraint at least every 2 hours, and maintain a record of the checks and usage; and
      2. (b) Shall provide opportunities for motion and exercise during each 2-hour period in which physical restraint is used, and shall monitor the use of the restraint use and maintain a record of it.
   2. (2) The attending physician shall ensure that treatment plans include provisions for the progressive elimination of physical restraints.

3. C. Use of Psychopharmacologic Drugs. When a physician prescribes psychopharmacologic drugs for a resident, the resident's clinical records shall contain all of the following documentation:

   1. (1) A physician's indication that the dosage, duration, indication, and monitoring are clinically appropriate and the reasons why they are clinically appropriate;
   2. (2) Indication that the resident is being monitored for adverse complications of the drug therapy;
   3. (3) Confirmation that previous attempts at dosage reduction have been unsuccessful, if applicable;
   4. (4) Evidence of the resident's subjective or objective improvement, or maintenance or function, while taking the medication;
   5. (5) Evidence that the resident's decline or deterioration, if applicable, has been evaluated by the interdisciplinary team to determine whether a particular drug, a particular dosage, or duration of therapy may be the cause;
   6. (6) Evidence of why the resident's age, weight, or other factors would require a unique drug dose, drug duration, indication, or monitoring; or
   7. (7) Other evidence that substantiates the use of the restraint.

Authority: Health-General Article, §§19-343—19-347 and 19-349—19-352, Annotated Code of Maryland

Effective date: December 30, 1977 (4:27 Md. R. 2107)

Regulations .01—.03 amended effective December 16, 1985 (12:25 Md. R. 2472)

Regulation .02K and .03K adopted effective August 30, 1982 (9:17 Md. R. 1708)

Regulation .03C amended effective August 30, 1982 (9:17 Md. R. 1708)

Regulations .01—.03 under COMAR 10.07.09 Patients' Bill of Rights: Comprehensive Care Facilities and Extended Care Facilities repealed and new Regulations .01—.20 under COMAR 10.07.09 Residents' Bill of Rights: Comprehensive Care Facilities and Extended Care Facilities adopted effective April 22, 1996 (23:8 Md. R. 605)

Regulation .02B amended effective January 5, 2004 (30:26 Md. R. 1914)

Regulation .08C amended effective March 13, 2017 (44:5 Md. R. 292)

Regulation .09 amended effective January 5, 2004 (30:26 Md. R. 1914)

Regulation .12A amended effective August 24, 2009 (36:17 Md. R. 1312)