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

2. B. Each order for seclusion, 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 seclusion 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 seclusion is appropriate; and
   2. (2) Document in the patient's medical record the observed behavior that confirms that the patient, if released from seclusion, 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 seclusion, 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 secluded.
5. E. Following the initial 24 hours of seclusion authorized under §C of this regulation, additional periods of restraint, not to exceed 24 hours each, may be authorized only if the seclusion 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 review the use of seclusion for that patient.

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

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

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 November 24, 2025 (52:23 Md. R. 1139)

Regulation .02B amended effective November 24, 2025 (52:23 Md. R. 1139)

Regulation .03 amended effective November 24, 2025 (52:23 Md. R. 1139)

Regulation .04 amended effective November 24, 2025 (52:23 Md. R. 1139)

Regulation .05C amended effective November 24, 2025 (52:23 Md. R. 1139)

Regulation .05I adopted effective November 24, 2025 (52:23 Md. R. 1139)

Regulation .06C amended effective November 24, 2025 (52:23 Md. R. 1139)

Regulation .07 amended effective November 24, 2025 (52:23 Md. R. 1139)

Regulation .08D amended effective November 24, 2025 (52:23 Md. R. 1139)

Regulation .01D, F amended effective November 24, 2025 (52:23 Md. R. 1139)

Regulation .12B amended effective November 24, 2025 (52:23 Md. R. 1139)