By Moncrief S.B. No. 876
77R1481 JJT-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the use of restraint, seclusion, and emergency
1-3 psychoactive medication in certain health care facilities.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subtitle G, Title 4, Health and Safety Code, is
1-6 amended by adding Chapter 322 to read as follows:
1-7 CHAPTER 322. USE OF RESTRAINT, SECLUSION, AND EMERGENCY
1-8 PSYCHOACTIVE MEDICATION IN CERTAIN HEALTH CARE FACILITIES
1-9 SUBCHAPTER A. GENERAL PROVISIONS
1-10 Sec. 322.001. DEFINITIONS. In this chapter:
1-11 (1) "Emergency" means a situation in which preventive
1-12 de-escalatory or redirection techniques are not appropriate or in
1-13 which attempted preventive de-escalatory or redirection techniques
1-14 have not effectively reduced the potential for injury a person's
1-15 behavior presents and in which it is immediately necessary to
1-16 intervene to prevent:
1-17 (A) imminent probable death or substantial
1-18 bodily harm to the person because the person overtly or continually
1-19 is threatening to or attempting to commit suicide or serious bodily
1-20 harm; or
1-21 (B) imminent physical harm to another because
1-22 the person overtly or continually makes or commits threats,
1-23 attempts, or other acts.
1-24 (2) "Emergency psychoactive medication" means
2-1 psychoactive medication, as defined by Section 574.101, that is
2-2 ordered and administered in an emergency to a person without the
2-3 person's consent.
2-4 (3) "Facility" means:
2-5 (A) a child-care institution, as defined by
2-6 Section 42.002, Human Resources Code, that is licensed by the
2-7 Department of Protective and Regulatory Services as a residential
2-8 treatment center or an institution serving children with mental
2-9 retardation;
2-10 (B) an intermediate care facility licensed by
2-11 the Texas Department of Human Services under Chapter 252 or
2-12 operated by the Texas Department of Human Services or the Texas
2-13 Department of Mental Health and Mental Retardation and exempt under
2-14 Section 252.003 from the licensing requirements of that chapter;
2-15 (C) a mental hospital or mental health facility,
2-16 as defined by Section 571.003;
2-17 (D) a nursing facility, as defined by Section
2-18 242.301; or
2-19 (E) an assisted living facility, as defined by
2-20 Section 247.002.
2-21 (4) "Health and human services agency" means an agency
2-22 listed in Section 531.001, Government Code.
2-23 (5) "Mechanical restraint" means a device used to
2-24 restrict the free movement of all or a portion of a person's body
2-25 to control the person's physical activity.
2-26 (6) "Personal restraint" means the application of
2-27 physical force to restrict the free movement of all or a portion of
3-1 a person's body. The term does not include physical redirection.
3-2 (7) "Physical redirection" means holding or touching a
3-3 person's hand, wrist, arm, shoulder, or back to induce the person
3-4 to walk to a safe location.
3-5 (8) "Protective device" means a device used to:
3-6 (A) prevent self-injury;
3-7 (B) permit wounds to heal;
3-8 (C) encourage mobility; or
3-9 (D) restrain an individual for safety.
3-10 (9) "Resident" means an individual who receives care
3-11 or treatment in a facility.
3-12 (10) "Restraint" includes mechanical or physical
3-13 restraint.
3-14 (11) "Seclusion" means the confinement of a person
3-15 alone in an area from which egress is prevented.
3-16 (12) "Supportive device" means a device used to
3-17 provide postural support for a person or to assist a person in
3-18 obtaining and maintaining normal bodily functioning.
3-19 Sec. 322.002. APPLICABILITY. This chapter applies to a
3-20 health and human services agency that regulates the care or
3-21 treatment of a resident.
3-22 Sec. 322.003. ADOPTION OF PROCEDURES. (a) A health and
3-23 human services agency by rule shall adopt procedures for the use on
3-24 a resident of:
3-25 (1) mechanical restraint;
3-26 (2) personal restraint;
3-27 (3) seclusion;
4-1 (4) emergency psychoactive medication; and
4-2 (5) supportive and protective devices.
4-3 (b) The procedures must be consistent with this chapter and
4-4 with the right of a resident to be free from:
4-5 (1) physical or mental abuse;
4-6 (2) corporal punishment; and
4-7 (3) the use of restraints or seclusion:
4-8 (A) as punishment;
4-9 (B) as a substitute for treatment or
4-10 habilitation;
4-11 (C) for the convenience of facility staff; or
4-12 (D) to compensate for a lack of facility staff.
4-13 Sec. 322.004. STAFF TRAINING. A facility shall provide to
4-14 its staff, annually or more frequently if necessary,
4-15 competency-based training on:
4-16 (1) procedures for managing a resident's behavior in
4-17 an emergency; and
4-18 (2) the prevention and de-escalation of a resident's
4-19 aggressive behavior.
4-20 Sec. 322.005. REPORT OF DEATH OR INJURY DURING OR AFTER
4-21 RESTRAINT, SECLUSION, OR EMERGENCY PSYCHOACTIVE MEDICATION. A
4-22 facility shall report to the appropriate law enforcement or
4-23 regulatory agencies for investigation a death of or serious injury
4-24 to a resident if the death or serious injury occurs during the use,
4-25 or less than 48 hours after the termination of the use, on the
4-26 resident of restraint, seclusion, or emergency psychoactive
4-27 medication.
5-1 Sec. 322.006. REPORTS. (a) Each quarter, a health and human
5-2 services agency that regulates a facility shall collect information
5-3 related to the facility's use of emergency interventions, including
5-4 the use of restraint, seclusion, and emergency psychoactive
5-5 medication.
5-6 (b) The information must include:
5-7 (1) the age, race, sex, and number of residents on
5-8 whom restraint, seclusion, or emergency psychoactive medication is
5-9 used, and the means by which those residents pay for treatment at
5-10 the facility;
5-11 (2) documentation regarding each death of or serious
5-12 physical injury to a resident described by Section 322.005; and
5-13 (3) autopsy findings for each death of a resident that
5-14 occurs before the 15th day after the date of the use of restraint,
5-15 seclusion, or emergency psychoactive medication on the resident.
5-16 (c) The agency annually shall submit an analysis of the
5-17 information collected under this section to the governor and the
5-18 presiding officer of each house of the legislature.
5-19 Sec. 322.007. CERTAIN RESTRAINTS PROHIBITED. A person may
5-20 not use a restraint that:
5-21 (1) places a resident face down while pressure is
5-22 placed on the resident's back;
5-23 (2) obstructs the resident's airway;
5-24 (3) impairs the resident's breathing; or
5-25 (4) restricts the resident's ability to communicate.
5-26 Sec. 322.008. NONEMERGENCY USE OF RESTRAINT OR SECLUSION.
5-27 Restraint may be used on a resident during medical, dental, or
6-1 postsurgical care, and seclusion may be used during medical care,
6-2 if its use is necessary and is a regular and customary part of the
6-3 care.
6-4 Sec. 322.009. USE OF EMERGENCY PSYCHOACTIVE MEDICATION IN
6-5 CONJUNCTION WITH USE OF RESTRAINT OR SECLUSION. (a) Emergency
6-6 psychoactive medication may be administered to a resident at the
6-7 time restraint or seclusion is used on the resident only if
6-8 clinically justified.
6-9 (b) Facility staff shall document the specific behaviors
6-10 that make the conjunctive use of the different intervention methods
6-11 necessary.
6-12 (c) When emergency psychoactive medication is used on a
6-13 resident while restraint or seclusion is used on the resident,
6-14 facility staff shall:
6-15 (1) continuously observe the resident; and
6-16 (2) document the use of each intervention and the
6-17 resident's response to each intervention.
6-18 Sec. 322.010. LIMITATION ON USE OF SECLUSION. Seclusion may
6-19 not be used for a resident receiving care or treatment in:
6-20 (1) an institution that serves children with mental
6-21 retardation;
6-22 (2) an intermediate care facility;
6-23 (3) a nursing home; or
6-24 (4) an assisted living facility.
6-25 Sec. 322.011. USE OF SUPPORTIVE OR PROTECTIVE DEVICE. (a) A
6-26 supportive or protective device may not be used as a substitute for
6-27 habilitative or rehabilitative care of a resident.
7-1 (b) A protective device may be used on a resident to:
7-2 (1) prevent self-injury;
7-3 (2) permit a wound to heal;
7-4 (3) encourage mobility; or
7-5 (4) restrain a resident for safety.
7-6 (c) A protective device may not be used as:
7-7 (1) a form of punishment;
7-8 (2) a substitute for treatment; or
7-9 (3) a convenience to caregivers.
7-10 (d) A supportive device may be used to provide postural
7-11 support for a resident to assist the resident in obtaining or
7-12 maintaining a normal bodily function.
7-13 (e) Facility staff shall periodically review the use of a
7-14 supportive or protective device on a resident and, where
7-15 practicable, develop a plan to overcome the need for the device.
7-16 (Sections 322.012-322.020 reserved for expansion
7-17 SUBCHAPTER B. USE OF RESTRAINT, SECLUSION, OR EMERGENCY
7-18 PSYCHOACTIVE MEDICATION IN CERTAIN FACILITIES FOR CHILDREN
7-19 Sec. 322.021. APPLICABILITY. This subchapter applies only to
7-20 a child-care institution, as defined by Section 42.002, Human
7-21 Resources Code, that is licensed by the Department of Protective
7-22 and Regulatory Services as a residential treatment center or an
7-23 institution serving children with mental retardation.
7-24 Sec. 322.022. RESTRAINT, SECLUSION, OR EMERGENCY
7-25 PSYCHOACTIVE MEDICATION AS RESPONSE TO EMERGENCY. Except as
7-26 provided by Section 322.008, restraint, seclusion, or emergency
7-27 psychoactive medication may be used on a resident only in an
8-1 emergency. Seclusion may not be used on a resident with mental
8-2 retardation.
8-3 Sec. 322.023. INITIATION OF AND PHYSICIAN'S ORDER FOR USE OF
8-4 RESTRAINT, SECLUSION, OR EMERGENCY PSYCHOACTIVE MEDICATION. (a)
8-5 The use of restraint, seclusion, or emergency psychoactive
8-6 medication may be initiated only by a member of a facility's staff
8-7 who has completed competency-based training in the use of
8-8 behavioral interventions and de-escalation techniques.
8-9 (b) Use of a mechanical restraint, seclusion, or emergency
8-10 psychoactive medication may proceed only under a physician's
8-11 written order. A physician must issue the order not more than one
8-12 hour after the use of the restraint, seclusion, or medication is
8-13 initiated.
8-14 (c) A physician may not authorize the use of a mechanical
8-15 restraint or seclusion by a pro re nata (PRN) order.
8-16 Sec. 322.024. CONSIDERATIONS BEFORE ISSUANCE OF ORDER. In
8-17 determining whether to order or continue the use of a mechanical
8-18 restraint, seclusion, or emergency psychoactive medication, a
8-19 physician shall consider medical and psychiatric contraindications,
8-20 including a resident's history regarding physical or sexual abuse
8-21 or substance abuse.
8-22 Sec. 322.025. DOCUMENTATION SUPPORTING USE. (a) A facility
8-23 that uses restraint, seclusion, or emergency psychoactive
8-24 medication shall document:
8-25 (1) the specific behavior that constitutes the
8-26 emergency;
8-27 (2) the specific de-escalation techniques used to
9-1 manage the resident's behavior before the use of the restraint,
9-2 seclusion, or medication; and
9-3 (3) the response of the resident to those techniques.
9-4 (b) The member of the staff who initiates the use of
9-5 restraint, seclusion, or emergency psychoactive medication shall
9-6 sign the document described by Subsection (a).
9-7 Sec. 322.026. CONSULTATION REGARDING ALTERNATIVE TREATMENT
9-8 STRATEGIES. If any combination of restraint, seclusion, or
9-9 emergency psychoactive medication is used on a resident three or
9-10 more times in a 30-day period, staff members who are treating the
9-11 resident shall consult with a clinician who is not treating the
9-12 resident to explore alternative treatment strategies.
9-13 Sec. 322.027. LIMITATION ON USE OF MECHANICAL RESTRAINT. A
9-14 mechanical restraint may be used only on a resident receiving care
9-15 or treatment in a facility that:
9-16 (1) serves persons with mental retardation
9-17 exclusively; or
9-18 (2) is a residential treatment facility licensed by
9-19 the Department of Protective and Regulatory Services.
9-20 Sec. 322.028. PHYSICIAN'S ORDER FOR USE OF MECHANICAL
9-21 RESTRAINT. A physician's order for the use of a mechanical
9-22 restraint must specify:
9-23 (1) the maximum duration of the use of the restraint;
9-24 (2) the date and time of its use; and
9-25 (3) specific behaviors for release.
9-26 Sec. 322.029. DURATION OF USE OF MECHANICAL RESTRAINT. (a)
9-27 The use of a mechanical restraint on a resident must end at the
10-1 earliest possible time. Except as provided by Subsection (b), a
10-2 mechanical restraint may not be used on a resident for longer than:
10-3 (1) 30 minutes for a resident younger than nine years
10-4 of age;
10-5 (2) one hour for a resident at least nine years of age
10-6 but younger than 18 years of age; or
10-7 (3) two hours for a resident 18 years of age or older.
10-8 (b) The use of a mechanical restraint may not proceed beyond
10-9 the time provided by the original order unless its use is
10-10 authorized by a physician after the physician conducts an in-person
10-11 evaluation. A mechanical restraint may not be used continuously
10-12 under the original order and one or more continuations of the order
10-13 for longer than a total of 12 hours.
10-14 Sec. 322.030. MONITORING RESIDENT UNDER MECHANICAL
10-15 RESTRAINT. While a mechanical restraint is used on a resident,
10-16 facility staff shall:
10-17 (1) observe the resident continuously;
10-18 (2) provide the resident with the opportunity to drink
10-19 water and use a toilet every two hours and more frequently if
10-20 needed; and
10-21 (3) monitor the resident's circulation, skin color,
10-22 respiration, and range of motion.
10-23 Sec. 322.031. USE OF PERSONAL RESTRAINT. (a) The use of
10-24 personal restraint on a resident must end at the earliest possible
10-25 time.
10-26 (b) Facility staff shall continuously observe a resident
10-27 under personal restraint and monitor the resident's breathing.
11-1 Sec. 322.032. SAFE AND OBSERVABLE AREA FOR SECLUSION. An
11-2 area used for seclusion must:
11-3 (1) be free of hazards that may cause physical injury
11-4 to a resident; and
11-5 (2) permit the direct observation of a resident in the
11-6 area.
11-7 Sec. 322.033. DURATION OF SECLUSION. The seclusion of a
11-8 resident must end at the earliest possible time.
11-9 Sec. 322.034. OPPORTUNITY FOR WATER AND TOILET. Facility
11-10 staff shall provide a resident under seclusion with the opportunity
11-11 to drink water and use a toilet every two hours and more frequently
11-12 if needed.
11-13 (Sections 322.035-322.080 reserved for expansion
11-14 SUBCHAPTER C. USE OF RESTRAINT, SECLUSION, OR EMERGENCY
11-15 PSYCHOACTIVE MEDICATION IN INTERMEDIATE CARE FACILITY
11-16 Sec. 322.081. APPLICABILITY. This subchapter applies only
11-17 to an intermediate care facility licensed by the Texas Department
11-18 of Human Services under Chapter 252 or operated by the Texas
11-19 Department of Human Services or the Texas Department of Mental
11-20 Health and Mental Retardation and exempt under Section 252.003 from
11-21 the licensing requirements of that chapter.
11-22 Sec. 322.082. DEFINITION. In this subchapter, "exclusionary
11-23 time-out" means the placement, in accordance with an approved
11-24 individualized behavior intervention program, of a resident who
11-25 exhibits maladaptive behavior in an enclosed area from which the
11-26 resident is prevented from leaving until the resident exhibits
11-27 appropriate behavior.
12-1 Sec. 322.083. SECLUSION PROHIBITED. Seclusion may not be
12-2 used on a resident of an intermediate care facility.
12-3 Sec. 322.084. USE OF EXCLUSIONARY TIME-OUT. (a) An
12-4 exclusionary time-out may be used only in accordance with
12-5 applicable federal law and for a period not to exceed one hour.
12-6 (b) A person may not place a resident alone in a locked room
12-7 as part of an exclusionary time-out.
12-8 Sec. 322.085. INITIATION OF AND PHYSICIAN'S ORDER FOR USE OF
12-9 RESTRAINT, TIME-OUT, OR EMERGENCY PSYCHOACTIVE MEDICATION. (a) The
12-10 use of restraint, exclusionary time-out, or emergency psychoactive
12-11 medication may be initiated only by a member of a facility's staff
12-12 who has completed competency-based training in the use of
12-13 behavioral interventions and de-escalation techniques.
12-14 (b) Use of restraint or emergency psychoactive medication
12-15 may proceed only under a physician's order. The use of
12-16 exclusionary time-out may proceed only under a physician's order or
12-17 as specified in the resident's behavior plan. A physician must
12-18 issue the order not more than one hour after the use of the
12-19 restraint, exclusionary time-out, or emergency psychoactive
12-20 medication is initiated.
12-21 (c) A physician may not authorize the use of restraint or
12-22 emergency psychoactive medication by a pro re nata (PRN) order.
12-23 Sec. 322.086. CONSIDERATIONS BEFORE ISSUANCE OF ORDER. In
12-24 determining whether to order or continue the use of restraint,
12-25 exclusionary time-out, or emergency psychoactive medication, a
12-26 physician shall consider medical and psychiatric contraindications,
12-27 including a resident's history regarding physical or sexual abuse
13-1 or substance abuse.
13-2 Sec. 322.087. DOCUMENTATION SUPPORTING USE. (a) A facility
13-3 that uses restraint, exclusionary time-out, or emergency
13-4 psychoactive medication shall document:
13-5 (1) the specific behavior that constitutes the reason
13-6 for the use of the restraint, time-out, or medication;
13-7 (2) the specific de-escalation techniques used to
13-8 manage the resident's behavior before the use of the restraint,
13-9 time-out, or medication; and
13-10 (3) the response of the resident to those techniques.
13-11 (b) The member of the staff who initiates the use of
13-12 restraint, exclusionary time-out, or emergency psychoactive
13-13 medication shall sign the document described by Subsection (a).
13-14 (c) Subsections (a) and (b) do not apply when the use of
13-15 exclusionary time-out is as provided in the resident's behavior
13-16 plan.
13-17 Sec. 322.088. CONSULTATION REGARDING ALTERNATIVE TREATMENT
13-18 STRATEGIES. (a) If any combination of restraint, exclusionary
13-19 time-out, or emergency psychoactive medication is used on a
13-20 resident three or more times in a 30-day period, staff members,
13-21 including a behavior specialist and other necessary specialists,
13-22 shall meet to explore alternative or additional treatment
13-23 strategies.
13-24 (b) Subsection (a) does not apply if the use of exclusionary
13-25 time-out is as provided by the resident's behavior plan.
13-26 Sec. 322.089. PHYSICIAN'S ORDER FOR USE OF MECHANICAL
13-27 RESTRAINT. A physician's order for the use of a mechanical
14-1 restraint must specify:
14-2 (1) the maximum duration of the use of the restraint;
14-3 (2) the date and time of its use; and
14-4 (3) specific behaviors for release.
14-5 Sec. 322.090. DURATION OF USE OF MECHANICAL RESTRAINT. (a)
14-6 The use of a mechanical restraint on a resident must end at the
14-7 earliest possible time. Except as provided by Subsection (b), a
14-8 mechanical restraint may not be used on a resident for longer than:
14-9 (1) 30 minutes for a resident younger than nine years
14-10 of age;
14-11 (2) one hour for a resident who is:
14-12 (A) at least 9 years of age but younger than 18
14-13 years of age; or
14-14 (B) 65 years of age or older; or
14-15 (3) two hours for a resident 18 years of age or older
14-16 but younger than 65 years of age.
14-17 (b) The use of a mechanical restraint may not proceed beyond
14-18 the time provided by the original order unless its use is
14-19 authorized by a physician after the physician conducts an in-person
14-20 evaluation.
14-21 (c) A mechanical restraint may not be used continuously
14-22 under the original order and one or more continuations of the order
14-23 for longer than a total of 12 hours.
14-24 Sec. 322.091. MONITORING RESIDENT UNDER MECHANICAL
14-25 RESTRAINT. While a mechanical restraint is used on a resident,
14-26 facility staff shall:
14-27 (1) observe the resident continuously;
15-1 (2) provide the resident with the opportunity to drink
15-2 water and use a toilet every two hours and more frequently if
15-3 needed; and
15-4 (3) monitor the resident's circulation, skin color,
15-5 respiration, and range of motion.
15-6 Sec. 322.092. USE OF PERSONAL RESTRAINT. (a) The use of
15-7 personal restraint on a resident must end at the earliest possible
15-8 time.
15-9 (b) Facility staff shall continuously observe a resident
15-10 under personal restraint and monitor the resident's breathing.
15-11 (Sections 322.093-322.130 reserved for expansion
15-12 SUBCHAPTER D. USE OF RESTRAINT, SECLUSION, OR EMERGENCY
15-13 PSYCHOACTIVE MEDICATION IN MENTAL HOSPITAL OR
15-14 MENTAL HEALTH FACILITY
15-15 Sec. 322.131. APPLICABILITY. This subchapter applies only to
15-16 a mental hospital or mental health facility, as defined by Section
15-17 571.003.
15-18 Sec. 322.132. RESTRAINT, SECLUSION, OR EMERGENCY
15-19 PSYCHOACTIVE MEDICATION AS RESPONSE TO EMERGENCY. Except as
15-20 provided by Section 322.008, restraint, seclusion, or emergency
15-21 psychoactive medication may be used on a resident only in an
15-22 emergency.
15-23 Sec. 322.133. INITIATION OF AND PHYSICIAN'S ORDER FOR USE OF
15-24 RESTRAINT, SECLUSION, OR EMERGENCY PSYCHOACTIVE MEDICATION. (a)
15-25 The use of restraint, seclusion, or emergency psychoactive
15-26 medication may be initiated only by a member of a facility's staff
15-27 who has completed competency-based training in the use of
16-1 behavioral interventions and de-escalation techniques.
16-2 (b) Use of restraint, seclusion, or emergency psychoactive
16-3 medication may proceed only under a physician's written order. A
16-4 physician must issue the order not more than one hour after the use
16-5 of the restraint, seclusion, or medication is initiated.
16-6 (c) A physician may not authorize the use of restraint,
16-7 seclusion, or emergency psychoactive medication by a pro re nata
16-8 (PRN) order.
16-9 Sec. 322.134. CONSIDERATIONS BEFORE ISSUANCE OF ORDER. In
16-10 determining whether to order or continue the use of restraint,
16-11 seclusion, or emergency psychoactive medication, a physician shall
16-12 consider medical and psychiatric contraindications, including a
16-13 resident's history regarding physical or sexual abuse or substance
16-14 abuse.
16-15 Sec. 322.135. DOCUMENTATION SUPPORTING USE. (a) A facility
16-16 that uses restraint, seclusion, or emergency psychoactive
16-17 medication shall document:
16-18 (1) the specific behavior that constitutes the
16-19 emergency, if applicable;
16-20 (2) the specific de-escalation techniques used to
16-21 manage the resident's behavior before the use of the restraint,
16-22 seclusion, or medication; and
16-23 (3) the response of the resident to those techniques.
16-24 (b) The member of the staff who initiates the use of
16-25 restraint, seclusion, or emergency psychoactive medication shall
16-26 sign the document described by Subsection (a).
16-27 Sec. 322.136. CONSULTATION REGARDING ALTERNATIVE TREATMENT
17-1 STRATEGIES. If any combination of restraint, seclusion, or
17-2 emergency psychoactive medication is used on a resident three or
17-3 more times in a 30-day period, staff members who are treating the
17-4 resident shall consult with a clinician who is not treating the
17-5 resident to explore alternative treatment strategies.
17-6 Sec. 322.137. PHYSICIAN'S ORDER FOR USE OF MECHANICAL
17-7 RESTRAINT. A physician's order for the use of a mechanical
17-8 restraint must specify:
17-9 (1) the maximum duration of the use of the restraint;
17-10 (2) the date and time of its use; and
17-11 (3) specific behaviors for release.
17-12 Sec. 322.138. DURATION OF USE OF MECHANICAL RESTRAINT. (a)
17-13 The use of a mechanical restraint on a resident must end at the
17-14 earliest possible time. Except as provided by Subsection (b), a
17-15 mechanical restraint may not be used on a resident for longer than:
17-16 (1) 30 minutes for a resident younger than 9 years of
17-17 age;
17-18 (2) one hour for a resident who is:
17-19 (A) at least 9 years of age but younger than 18
17-20 years of age; or
17-21 (B) 65 years of age or older; or
17-22 (3) two hours for a resident 18 years of age or older
17-23 but younger than 65 years of age.
17-24 (b) The use of a mechanical restraint may not proceed beyond
17-25 the time provided by the original order unless its use is
17-26 authorized by a physician after the physician conducts an in-person
17-27 evaluation.
18-1 (c) A mechanical restraint may not be used continuously
18-2 under the original order and one or more continuations of the order
18-3 for longer than a total of 12 hours.
18-4 Sec. 322.139. MONITORING OF RESIDENT UNDER MECHANICAL
18-5 RESTRAINT. While a mechanical restraint is used on a resident,
18-6 facility staff shall:
18-7 (1) observe the resident continuously;
18-8 (2) provide the resident with the opportunity to drink
18-9 water and use a toilet every two hours and more frequently if
18-10 needed; and
18-11 (3) monitor the resident's circulation, skin color,
18-12 respiration, and range of motion.
18-13 Sec. 322.140. USE OF PERSONAL RESTRAINT. (a) The use of
18-14 personal restraint on a resident must end at the earliest possible
18-15 time.
18-16 (b) Facility staff shall continuously observe a resident
18-17 under personal restraint and monitor the resident's breathing.
18-18 Sec. 322.141. SAFE AND OBSERVABLE AREA FOR SECLUSION. An
18-19 area used for seclusion must:
18-20 (1) be free of hazards that may cause physical injury
18-21 to a resident; and
18-22 (2) permit the direct observation of a resident in the
18-23 area.
18-24 Sec. 322.142. DURATION OF SECLUSION. The seclusion of a
18-25 resident must end at the earliest possible time.
18-26 Sec. 322.143. OPPORTUNITY FOR WATER AND TOILET. Facility
18-27 staff shall provide a resident under seclusion with the opportunity
19-1 to drink water and use a toilet every two hours and more frequently
19-2 if needed.
19-3 (Sections 322.144-322.180 reserved for expansion
19-4 SUBCHAPTER E. USE OF RESTRAINT, SECLUSION, OR EMERGENCY
19-5 PSYCHOACTIVE MEDICATION IN NURSING FACILITY
19-6 Sec. 322.181. APPLICABILITY. This subchapter applies only to
19-7 a nursing facility, as defined by Section 242.301.
19-8 Sec. 322.182. SECLUSION PROHIBITED. Seclusion may not be
19-9 used on a resident of a nursing facility.
19-10 Sec. 322.183. RESTRAINT OR EMERGENCY PSYCHOACTIVE MEDICATION
19-11 AS RESPONSE TO EMERGENCY. Except as provided by Section 322.008,
19-12 restraint or emergency psychoactive medication may be used on a
19-13 resident only in an emergency.
19-14 Sec. 322.184. INITIATION OF AND PHYSICIAN'S ORDER FOR USE OF
19-15 RESTRAINT OR EMERGENCY PSYCHOACTIVE MEDICATION. (a) The use of
19-16 restraint or emergency psychoactive medication may be initiated
19-17 only by a member of a facility's staff who has completed
19-18 competency-based training in the use of behavioral interventions
19-19 and de-escalation techniques.
19-20 (b) Use of restraint or emergency psychoactive medication
19-21 may proceed only under a physician's order. A physician must issue
19-22 the order not more than one hour after the use of the restraint or
19-23 medication is initiated.
19-24 (c) A physician may not order the use of restraint or
19-25 emergency psychoactive medication by a pro re nata (PRN) order.
19-26 Sec. 322.185. CONSIDERATIONS BEFORE ISSUANCE OF ORDER. In
19-27 determining whether to order or continue the use of restraint or
20-1 emergency psychoactive medication, a physician shall consider
20-2 medical and psychiatric contraindications, including a resident's
20-3 history regarding physical or sexual abuse or substance abuse.
20-4 Sec. 322.186. DOCUMENTATION SUPPORTING USE. (a) A facility
20-5 that uses restraint or emergency psychoactive medication shall
20-6 document:
20-7 (1) the specific behavior that constitutes the
20-8 emergency, if applicable;
20-9 (2) the specific de-escalation techniques used to
20-10 manage the resident's behavior before the use of the restraint or
20-11 medication; and
20-12 (3) the response of the resident to those techniques.
20-13 (b) The member of the staff who initiates the use of
20-14 restraint or emergency psychoactive medication shall sign the
20-15 document described by Subsection (a).
20-16 Sec. 322.187. CONSULTATION REGARDING ALTERNATIVE TREATMENT
20-17 STRATEGIES. If any combination of restraint or emergency
20-18 psychoactive medication is used on a resident three or more times
20-19 in a 30-day period, staff members who are treating the resident
20-20 shall consult with a clinician who is not treating the resident to
20-21 explore alternative treatment strategies.
20-22 Sec. 322.188. PHYSICIAN'S ORDER FOR USE OF MECHANICAL
20-23 RESTRAINT. A physician's order for the use of a mechanical
20-24 restraint must specify:
20-25 (1) the maximum duration of the use of the restraint;
20-26 (2) the date and time of its use; and
20-27 (3) specific behaviors for release.
21-1 Sec. 322.189. DURATION OF USE OF MECHANICAL RESTRAINT. (a)
21-2 The use of a mechanical restraint on a resident must end at the
21-3 earliest possible time. Except as provided by Subsection (b), a
21-4 mechanical restraint may not be used on a resident for longer than:
21-5 (1) 30 minutes for a resident younger than 9 years of
21-6 age;
21-7 (2) one hour for a resident who is:
21-8 (A) at least 9 years of age but younger than 18
21-9 years of age; or
21-10 (B) 65 years of age or older; or
21-11 (3) two hours for a resident 18 years of age or older
21-12 but younger than 65 years of age.
21-13 (b) The use of a mechanical restraint may not proceed beyond
21-14 the time provided by the original order unless its use is
21-15 authorized by a physician after the physician conducts an in-person
21-16 evaluation.
21-17 (c) A mechanical restraint may not be used continuously
21-18 under the original order and one or more continuations of the order
21-19 for longer than a total of 12 hours.
21-20 Sec. 322.190. MONITORING RESIDENT UNDER MECHANICAL
21-21 RESTRAINT. While a mechanical restraint is used on a resident,
21-22 facility staff shall:
21-23 (1) observe the resident continuously;
21-24 (2) provide the resident with the opportunity to drink
21-25 water and use a toilet every two hours and more frequently if
21-26 needed; and
21-27 (3) monitor the resident's circulation, skin color,
22-1 respiration, and range of motion.
22-2 Sec. 322.191. USE OF PERSONAL RESTRAINT. (a) The use of
22-3 personal restraint on a resident must end at the earliest possible
22-4 time.
22-5 (b) Facility staff shall continuously observe a resident
22-6 under personal restraint and monitor the resident's breathing.
22-7 (Sections 322.192-322.220 reserved for expansion
22-8 SUBCHAPTER F. USE OF RESTRAINT, SECLUSION, OR EMERGENCY
22-9 PSYCHOACTIVE MEDICATION IN ASSISTED LIVING FACILITY
22-10 Sec. 322.221. APPLICABILITY. This subchapter applies only to
22-11 an assisted living facility, as defined by Section 247.002.
22-12 Sec. 322.222. USE OF MECHANICAL RESTRAINT, PSYCHOACTIVE
22-13 MEDICATION, OR SECLUSION PROHIBITED. A mechanical restraint,
22-14 emergency psychoactive medication, or seclusion may not be used on
22-15 a resident receiving care or treatment in a facility.
22-16 Sec. 322.223. USE OF PERSONAL RESTRAINT. (a) The use of
22-17 personal restraint on a resident must end at the earliest possible
22-18 time.
22-19 (b) Facility staff continuously shall observe a resident
22-20 under personal restraint and monitor the resident's breathing.
22-21 SECTION 2. A health and human services agency described by
22-22 Section 322.002, Health and Safety Code, as added by this Act,
22-23 shall adopt rules as necessary to implement Chapter 322, Health and
22-24 Safety Code, as added by this Act, not later than January 1, 2002.
22-25 SECTION 3. This Act takes effect September 1, 2001, except
22-26 that Section 1 takes effect January 1, 2002.