OAR 309-033-0720: Application, Training and Minimum Staffing Requirements

(1) Only the following facilities shall be certified pursuant to this rule and the procedures found OAR 309-008-0100 to 309-008-1600 to use seclusion or restraint: (a) Community hospitals licensed by the Public Health Division; (b) Regional acute care facilities for adults certified by the Division pursuant to OAR 309-032-0850 through 309-032-0890; and (c) Nonhospital facilities certified by the Division pursuant to OAR 309-033-0500 through 309-033-0550. (2) Applications. Certification for the use of seclusion and restraints must be accomplished by submission of an application, and by the application process described in OAR 309-008-0100 to 309-008-1600. Continued certification is subject to hospital or facility reviews at frequencies determined by the Division. (3) Requirements for Certification. In order to be certified for the use of seclusion and restraint, the Division must be satisfied that the hospital or facility meets the following requirements: (a) Medical staffing. An adequate number of nurses, direct care staff, Licensed Independent Practitioners (LIP) or physician assistants shall be available at the hospital or facility, to provide emergency medical services which may be required. For hospitals, a letter from the chief of the medical staff or medical director of the hospital or facility, ensuring such availability, shall constitute satisfaction of this requirement. For nonhospital facilities, a written agreement with a local hospital, to provide such medical services may fulfill this requirement. When such an agreement is not possible, a written agreement with a local physician to provide such medical services may fulfill this requirement. (b) Direct Care Staff Training. A staff person must be trained and able to demonstrate competency in the application of restraints and implementation of seclusion during the following intervals: (A) A new staff person must be trained within the six months prior to providing direct patient care or as part of orientation; and (B) Subsequently on a periodic basis consistent with the hospital or facility policy. (c) Documentation in the staff personnel records must indicate the training and demonstration of competency were successfully completed. (d) Trainer Qualifications. Individuals providing staff training must be qualified as evidenced by education, training, and experience in techniques used to address a person’s behaviors. (e) Training Curriculum. The training required for direct care staff must include: (A) Standards for the proper use of seclusion and restraints as described in OAR 309-033-0730; (B) Identification of medication side effects; (C) Indicators of medical problems and medical crisis; (D) Techniques to identify staff and patient behaviors, events, and environmental factors that may trigger circumstances that require the use of a restraint or seclusion; (E) The use of non-physical intervention skills; (F) Choosing the least restrictive intervention based on an individualized assessment of the person’s medical, or behavioral status or condition; (G) The safe application and use of all types of restraint or seclusion used in the hospital or facility, including training in how to recognize and respond to sign of physical or psychological distress; (H) Clinical identification of specific behavioral changes that indicate that restraint or seclusion is no longer necessary; (I) Monitoring the physical and psychological well-being of the patient who is restrained or secluded, including but not limited to respiratory and circulatory status, skin integrity, vital signs, and any special requirements specified by the hospital or facility policies and procedures; and (J) The use of first aid techniques and certification in the use of cardio-pulmonary resuscitation, including periodic recertification.