OAR 309-112-0015: Use of Seclusion or Restraint

(1) Initial Seclusion or Restraint Authorization: (a) The initial use of seclusion or restraint may be imposed on a patient by any trained OSH staff member when the patient poses an imminent risk of physical danger to the patient or others. (b) If the trained OSH staff member initiating seclusion or restraint does not have legal authority to order seclusion or restraint, a registered nurse or licensed practical nurse must contact a licensed physician or nurse practitioner, who is responsible for the care of the patient and authorized to order seclusion or restraint by hospital policy and in accordance with State law, as soon as it can safely be accomplished. (c) Upon being contacted, the licensed physician or nurse practitioner will determine whether a seclusion or restraint order should be issued. If the licensed physician or nurse practitioner determines that seclusion or restraint should not be continued, the patient must be released immediately from seclusion or restraint. If the licensed physician or nurse practitioner determines that seclusion or restraint should be continued, the seclusion or restraint order must be placed in the patient’s medical record. (d) No later than the end of their work shift, the OSH staff member who authorized and carried out the use of the initial seclusion or restraint must document the following in the patient’s medical record, including but not limited to: (A) A description of the patient’s specific behavior, condition or symptoms that warranted the use of seclusion or restraint; (B) Alternatives or other less restrictive interventions attempted or considered, if any; (C) The type of restraint or seclusion used and the reason it was selected; and (D) The patient’s response to the seclusion or restraint. (e) If the patient remains in initial seclusion or restraint without an order for more than 15 minutes, the OSH staff member who authorized the initial seclusion or restraint must complete and file an incident report. (2) Seclusion or Restraint Order Authorization: (a) Except for an initial seclusion or restraint under section (3) of this rule, seclusion or restraint may only be ordered by a physician or nurse practitioner who is responsible for the care of the patient, authorized to order seclusion or restraint by hospital policy and State law, and has been trained on hospital policy and applicable administrative rules related to the use of seclusion or restraint. (b) Orders for the use of seclusion or restraint must never be written as a standing order or on an as needed basis (PRN). (c) The attending physician or nurse practitioner must be consulted as soon as possible if the attending physician or nurse practitioner did not order the seclusion or restraint. (d) The written order for seclusion or restraint must be placed in the patient’s medical record. The use of a seclusion or restraint should be reflected in the patient’s plan of care or treatment plan based on an assessment and evaluation of the patient. (e) No later than the end of their work shift, the physician or nurse practitioner who issued the seclusion or restraint order must document the following in the patient’s medical record, including but not limited to: (A) A description of the patient’s specific behavior, condition or symptoms that warranted the use of seclusion or restraint; (B) Alternatives or other less restrictive interventions attempted or considered, if any; (C) The type of restraint or seclusion used and the reason it was selected; and (D) The patient’s response to seclusion or restraint. (3) Duration of Seclusion or Restraint Order: (a) An order for seclusion or restraint is for a maximum duration of 4 hours and may be renewed for a total of 24 hours. The physician or nurse practitioner, who authorizes a 4-hour renewal, must ensure the renewal and the rationale for continued use of seclusion or restraint is documented in the patient’s medical record. (b) Before writing a new order for seclusion or restraint after 24 hours, a physician or nurse practitioner, who is responsible for the care of the patient and authorized to order restraint or seclusion by hospital policy in accordance with State law, must conduct a face-to-face assessment of the patient to determine if the patient still poses a risk of imminent physical danger to the patient or others. The new written order for seclusion or restraint must be placed in the patient’s medical record and included in a written modification to the patient’s treatment care plan. (c) No later than the end of their work shift, the physician or nurse practitioner who issued the new seclusion or restraint order must document the following in the patient’s medical record, including but not limited to: (A) A description of the patient’s specific behavior, condition or symptoms that warranted the use of seclusion or restraint; (B) Alternatives or other less restrictive interventions attempted or considered; (C) The type of restraint or seclusion used and the reason it was selected; and (D) The patient’s response to seclusion or restraint; and (E) The rationale for continued use of seclusion or restraint. (d) Seclusion or restraint must be discontinued at the earliest possible time, regardless of the length of time identified in the order. (4) Monitoring: (a) 1-Hour Face-to-Face Assessment After Seclusion or Restraint: (A) Within one hour of seclusion or restraint being imposed, a face-to-face assessment of the patient must be conducted by a: (i) Physician or nurse practitioner; or (ii) Registered nurse who has been trained on seclusion or restraints in accordance with hospital policy. If conducted by a trained registered nurse, the nurse must consult with the attending physician or nurse practitioner, who is responsible for the care of the patient as soon as possible after the completion of this assessment. (B) The 1-hour face-to-face assessment must include the evaluation of: (i) The patient’s imminent situation; (ii) The patient’s reaction to the seclusion or restraint; (iii) The patient’s medical and behavioral condition; and (iv) The need to continue or terminate the seclusion or restraint. (C) The physician, nurse practitioner or registered nurse, who completed the 1-hour face-to-face assessment, must document in the patient’s medical record that the 1-hour face-to-face assessment occurred and the determinations made on the assessment factors in subsection (4)(a)(B) of this rule. (b) Ongoing monitoring: (A) When a patient is in restraint, OSH staff must check on the patient at least every 15 minutes to monitor their health and safety, unless the patient’s condition requires more frequent checks; (i) During the 15-minute check, OSH Staff must review the patient’s basic individual needs (such as regular meals, personal hygiene, and sleep) as well as the patient’s need for good body alignment and circulation, and take any necessary actions to meet the patient’s basic individual needs; and (ii) OSH Staff must document in the patient’s medical record that the patient was checked every 15 minutes, that they reviewed the patient’s basic individual needs, and took any necessary actions to meet the patient’s basic individual needs. (B) When a patient is in seclusion, OSH staff must check on the patient to monitor their health and safety consistent with hospital policy, unless the patient’s condition requires more frequent checks. (i) OSH Staff must review the patient’s basic individual needs (such as regular meals, personal hygiene, and sleep) as well as the patient’s need for good body alignment and circulation, and take any necessary actions to meet the patient’s basic individual needs; and (ii) OSH Staff must document in the patient’s medical record that the patient was checked consistent with hospital policy, that they reviewed the patient’s basic individual needs, and took any necessary actions to meet the patient’s basic individual needs. (C) If the patient is simultaneously in restraint and in seclusion, OSH Staff must continually monitor the patient either by: (i) Face-to-face by an assigned, trained OSH Staff member; or (ii) By trained OSH Staff using both video and audio equipment. This monitoring must be in close proximity to the patient. (c) An awake patient must be provided the opportunity to move and stretch for a period not less than 10 minutes during each two hours of restraint. Partial release of the patient from restraint must be employed as necessary to permit motion without endangering OSH Staff and patients. OSH Staff must document opportunities for exercise in the patient’s medical record.