1. A. Staff may not initiate “standing” or “as needed” orders for restraint.

2. B. Each order for restraint, used for the management of an emergency in which the behavior of the patient places the patient or others in serious threat of violence or injury, may only be renewed in accordance with the following limits not to exceed 24 hours total:

   1. (1) Four hours for adults 18 years of age or older;
   2. (2) Two hours for children and adolescents 9 to 17 years of age; or
   3. (3) One hour for children under 9 years of age.

3. C. After 24 hours, before writing a new order for the use of restraint for the management of an emergency in which the behavior of the patient places the patient or others in serious threat of violence or injury, a physician must:

   1. (1) See, assess, and conduct a face-to-face evaluation of the patient to determine whether continuous restraint is appropriate;
   2. (2) Document in the patient's medical record the observed behavior that confirms that the patient, if released from restraint, would continue to present a danger to self or others;
   3. (3) Follow all requirements outlined in this chapter, including but not limited to §B of this regulation; and
   4. (4) Obtain the authorization of the clinical director or the clinical director's physician designee, neither of whom may be the treating physician.
4. D. Upon a request from a patient's treating physician, prior to authorizing continued restraint in accordance with §C(4) of this regulation, the clinical director or the clinical director's designee shall perform a face-to-face evaluation of the patient who is restrained.
5. E. Following the initial 24 hours of restraint authorized under §C of this regulation, additional periods of restraint, not to exceed 24 hours each, may be authorized only if the restraint is provided in accordance with §§B—D of this regulation.

6. F. Treatment Team Involvement.

   1. (1) Minimally, at regularly scheduled meetings, the patient's treatment team shall examine the use of restraint for that patient.

   2. (2) Within 5 working days from the initiation of continuous restraint, regardless of whether the patient remains in restraint, the treatment team shall:

      1. (a) When applicable, review the appropriateness of the continued use of restraint;
      2. (b) Establish and implement a plan to eliminate the need for further restraint; and
      3. (c) Identify a team member who shall explain to the patient the potential risks and benefits of continuous restraint.

Authority: Health-General Article, §§10-101(g) and 10-701, Annotated Code of Maryland

Effective date: October 25, 1993 (20:21 Md. R. 1654)

Regulation .01 amended effective February 14, 2026 (52:23 Md. R. 1139)

Regulation .02B amended effective February 14, 2026 (52:23 Md. R. 1139)

Regulation .03 amended effective February 14, 2026 (52:23 Md. R. 1139)

Regulation .05 amended effective February 14, 2026 (52:23 Md. R. 1139)

Regulation .06D amended effective February 14, 2026 (52:23 Md. R. 1139)

Regulation .08D amended effective February 14, 2026 (52:23 Md. R. 1139)

Regulation .09 amended effective February 14, 2026 (52:23 Md. R. 1139)

Regulation 10D amended effective February 14, 2026 (52:23 Md. R. 1139)

Regulation .12D, F amended effective February 14, 2026 (52:23 Md. R. 1139)