Definitions

(1) “Chemical restraint” means a medication that is prescribed to restrict the service recipient’s freedom of movement for the control of extreme violent physical behavior. Chemical restraints are medications used in addition to, or in replacement of, the service recipient’s regular drug regimen to control extreme violent physical behavior. The medications that comprise the service recipient’s regular medical regimen (including PRN medications) are not considered chemical restraints, even if their purpose is to treat ongoing behavioral symptoms. (2) “Conservator” means a person appointed by a court under the conservatorship laws in Title 34, Chapter 3, Tenn. Code Ann. or the Uniform Veterans’ Guardianship Law in Title 34, Chapter 5, Tenn. Code Ann. with authority to make decisions for an adult who lacks capacity to make informed health care decisions. (3) “Custodian” means an agency or individual appointed by a juvenile court to have full control of a service recipient who is a child. (4) “Durable power of attorney for health care” means a legal document authorized by Title 34, Chapter 6, Part 2, Tenn. Code Ann. that allows the attorney-in-fact to make decisions for health care. (5) “Emergency safety situation” means service recipient behavior that places the service recipient or others at serious threat of violence or injury or significant destruction of property, if the process of destroying the property puts the service recipient or persons nearby in danger, if no intervention occurs and calls for the use of isolation, mechanical restraint, or physical holding restraint. (6) “Guardian” means a person appointed by a court under Title 34, Chapter 2, Tenn. Code Ann. with authority to make decisions for a person under eighteen (18) years of age who lacks capacity to make informed health care decisions. (7) “Hospital” means a licensed public or private inpatient treatment resource or hospital or a part of such treatment resource or hospital that provides inpatient care and treatment for persons with mental illness or serious emotional disturbance. (8) “Involuntarily committed service recipient” means a service recipient who is receiving services on an involuntary basis under Title 33, Chapter 6, Part 4 or 5, Tenn. Code Ann., T.C.A. §§ 33-3-401—403, 412, 607, 33-7-301 and 303, or 37-1-128. (9) “Isolation” means the confinement of a service recipient alone in a room or an area where the service recipient is physically prevented from leaving. This definition is not limited to instances in which a service recipient is confined by a locked or closed door. Isolation does not include: (a) The segregation of a service recipient for the purpose of managing biological contagion consistent with the Centers for Disease Control Guidelines; (b) Confinement to a locked unit or ward where other service recipients are present. Isolation is not solely confinement of a service recipient to an area, but separation of the service recipient from other persons; or USE OF ISOLATION, MECHANICAL AND PHYSICAL HOLDING RESTRAINT CHAPTER 0940-03-09 IN MENTAL HEALTH RESIDENTIAL TREATMENT FACILITIES (c) Time-out, a behavior management procedure in which the opportunity for positive reinforcement is withheld, contingent upon the demonstration of undesired behavior. Time-out may involve the voluntary separation of an individual service recipient from others. (10) “Licensed practitioner” means an individual approved by the mental health residential treatment facility to order the use of isolation or mechanical restraint and who is licensed by the Tennessee Health Related Boards as a: (a) Physician (medical doctor or doctor of osteopathy); (b) Certified nurse practitioner; (c) Physician assistant; (d) Nurse with a master’s degree in nursing who functions as a psychiatric nurse; (e) Psychologist with health service provider designation; (f) Licensed professional counselor; (g) Senior psychological examiner; (h) Licensed marriage and family therapist; (i) Licensed clinical social worker; or (j) Licensed psychological examiner. (11) “Mechanical restraint” means the application of a mechanical device, material, or equipment attached or adjacent to the service recipient’s body, including ambulatory restraints, which the service recipient cannot easily remove and that restrict freedom of movement or normal access to the service recipient’s body. Mechanical restraint does not include the use of: (a) Restrictive devices or manual methods employed by a law enforcement agent or other public safety officer to maintain custody, detention, or public safety during the transport of a service recipient under the jurisdiction of the criminal justice system or juveniles with charges in the juvenile justice system; (b) Restraints for medical immobilization, adaptive support, or medical protection; or (c) Restrictive devices administratively ordered to ensure the safety of the service recipient or others when an involuntary committed service recipient must be transported. (12) “Mental health personnel” means a staff member who operates under the direct supervision of a licensed practitioner. (13) “Physical holding restraint” means the use of body contact by staff with a service recipient to restrict freedom of movement or normal access to his or her body. Physical holding restraint does not include the use of: (a) Physical touch associated with prompting, comforting or assisting that does not prevent the service recipient’s freedom of movement or normal access to his or her body; USE OF ISOLATION, MECHANICAL AND PHYSICAL HOLDING RESTRAINT CHAPTER 0940-03-09 IN MENTAL HEALTH RESIDENTIAL TREATMENT FACILITIES (b) Physical escort for the temporary touching or holding of the hand(s), wrist(s), arm(s), shoulder(s) or back for the purpose of inducing the service recipient to walk to a safe location; or (c) Physical intervention for the temporary holding of the hand(s), wrist(s), arm(s), shoulder(s), or leg(s) which does not otherwise restrict freedom of movement or access to one’s body, for the purpose of terminating unsafe behavior. (14) “PRN” means authorization written to allow a medication or treatment to be given on an as- needed basis. (15) “Seclusion” means “Isolation.” (16) “Service recipient,” for purposes of this chapter, means an individual receiving mental health residential treatment services. (17) “Temporary caregiver” means an individual designated under T.C.A. § 34-6-302 to make decisions as specified in § 34-6-304 for a minor child as assigned by the parent or parents on the form provided by the Department of Children’s Services for this purpose.