AUTHOR'S / SPONSOR'S STATEMENT OF INTENT
Staff at psychiatric facilities and hospitals must sometimes use restraint or seclusion to manage violent or self-destructive behavior that jeopardizes the immediate physical safety of the patient, a staff member, or others. Restraint and seclusion are used only as an emergency intervention to help patients re-establish control of their behavior, and only when less restrictive, non-physical interventions have proven unsuccessful.
Currently, the Department of State Health Services (DSHS) administrative rules that are more restrictive than the Centers for Medicare and Medicaid Services (CMS) rules and allow only a physician or a physician’s designee (an advanced nurse practitioner (ANP) or physician assistant (PA)) to conduct a face-to-face evaluation of the patient to assess his or her medical and psychiatric stability within one hour of the initiation of the restraint or seclusion. The evaluation includes the patient’s immediate situation, his or her reaction to the intervention, his or her medical and behavioral condition, and the need to continue or terminate the restraint or seclusion. The national CMS standard is to have that evaluation performed within an hour but allows for an appropriately trained and licensed registered nurse (RN) to perform the evaluation. RNs are used throughout the country to perform complex medical evaluations in emergency rooms, post-surgical recovery rooms, and intensive care units and relay that clinical evaluation to a physician for appropriate action. Currently, Texas and Massachusetts are the only states that do not allow RNs to conduct these evaluations.
S.B. 1842 requires DSHS to amend its administrative rules to expand the category of health care professionals permitted to perform face-to-face psychiatric evaluations of the medical and psychiatric stability of residents of inpatient psychiatric facilities who are placed in either seclusion or restraint. Current DSHS rules require that a physician conduct this evaluation within one hour of initiating the restraint or seclusion. The physician may delegate this evaluation to PA or an APN. S.B. 1842 adds RNs to the list of health care professionals authorized to conduct these evaluations, and requires RNs performing these evaluations to have undergone the same training required under DSHS rules and by CMS, which is specifically tailored to the evaluation of psychiatric patients placed in restraint or seclusion to ensure that RNs are competent to perform this evaluation.
As proposed, S.B. 1842 amends current law relating to rules for restraint and seclusion procedures at certain facilities.
RULEMAKING AUTHORITY
Rulemaking authority previously granted to the executive commissioner of the Health and Human Services Commission (executive commissioner) is modified in SECTION 1 (Section 322.052, Health and Safety Code) of this bill.
Rulemaking authority is expressly granted to the executive commissioner in SECTION 2 of this bill.
SECTION BY SECTION ANALYSIS
SECTION 1. Amends Section 322.052, Health and Safety Code, by adding Subsection (b-1), as follows:
(b-1) Requires that the rules required to be adopted by the executive commissioner of the Health and Human Services Commission (executive commissioner) require that a registered nurse who is trained to assess medical and psychiatric stability with demonstrated competence as required by rule conduct a face-to-face evaluation of a facility resident not later than one hour after the time the use of restraint and seclusion is initiated with respect to the resident.
SECTION 2. Requires the executive commissioner, not later than January 1, 2014, to adopt rules as required by Section 322.052(b-1), Health and Safety Code, as added by this Act.
SECTION 3. Effective date: upon passage or September 1, 2013.