ARM 37.106.3238. USE OF CRISIS INTERVENTION AND PHYSICAL RESTRAINT STRATEGIES

(1) The facility must have written policies and procedures governing the appropriate use of crisis intervention and physical restraint methods if used by the facility. (2) The crisis intervention and physical restraint policies and procedures must include evidence-based training and include: (a) suicide prevention training for all staff to include risk identification, screening and assessment, indicated interventions, safety planning, treatment, follow-up care, and documentation; (b) crisis prevention and verbal and nonverbal de-escalation techniques are the preferred methods and must be used first to manage behavior; (c) all staff must be trained in the facility’s crisis intervention, de-escalation techniques, and physical restraint methods; (d) physical restraint may only be used to safely control a resident until the resident can regain control of their own behavior; (e) physical restraint must only be used in the following circumstances: (i) when the resident has failed to respond to de-escalation techniques and it is necessary to prevent harm to the resident or others; or (ii) when a resident’s behavior puts themselves or others at substantial risk of harm and the resident must be forcibly moved; (f) physical restraint must be used only until the resident has regained control and must not exceed 15 consecutive minutes. If the resident remains a danger to self or others after 15 minutes, the resident’s record must include written documentation of attempts made to release the resident from the restraint and the reasons that continuation of restraint is necessary; and (g) physical restraint may be used only by staff who are documented to be specifically trained in crisis intervention and physical restraint techniques. (3) The facility policies and procedures must require the documentation of: (a) the specific behavior which required the physical restraint; (b) the specific attempts to de-escalate the situation before using physical restraint; (c) the length of time the physical restraint was applied including documentation of the time started and completed; (d) the identity of the specific staff member(s) involved in administering the physical restraint; (e) the type of physical restraint used; (f) any injuries to the resident resulting from the physical restraint; (g) debriefing completed with the staff and resident involved in the physical restraint; and (h) notification of the parent or legal guardian within 24 hours of restraint. (4) The documentation required in (3) must be submitted in writing to the Office of Inspector General Licensure Bureau within one business day of the physical restraint. (5) Facility policies and procedures must require that whenever a physical restraint has been used on a resident more than four times within a seven-day period, the administrator or designee will review the resident’s situation to determine the suitability of the resident to remain in the facility, whether modification of the case plan is warranted, or whether staff need additional training in alternative therapeutic behavior management techniques. The facility must take appropriate action as a result of the review. (6) Facility policies and procedures must prohibit the application of a physical restraint if a resident has a documented physical condition that would contradict its use, unless a licensed health care professional has previously and specifically authorized its use in writing. Documentation must be maintained in the resident’s file.