Section 481.58.43. Resident abuse prohibited.

Each resident shall receive kind and considerate care at all times and shall be free from mental, physical, sexual, and verbal abuse, exploitation, neglect, and physical injury. Each resident shall be free from chemical and physical restraints except as follows: when authorized in writing by a physician for a specified period of time; when necessary in an emergency to protect the resident from injury to the resident or to others, in which case restraints may be authorized by designated professional personnel who promptly report the action taken to the physician; and in the case of an intellectually disabled individual when ordered in writing by a physician and authorized by a designated qualified intellectual disabilities professional for use during behavior modification sessions. Mechanical supports used in normative situations to achieve proper body position and balance shall not be considered to be a restraint. (II)

        58.43(1) Mental abuse includes, but is not limited to, humiliation, harassment, and threats of punishment or deprivation. (II)

         58.43(2) Physical abuse includes, but is not limited to, corporal punishment and the use of restraints as punishment. (II)

         58.43(3) Drugs such as tranquilizers may not be used as chemical restraints to limit or control resident behavior for the convenience of staff. (II)

         58.43(4) Physicians’ orders are required to utilize all types of physical restraints and shall be renewed at least quarterly. (II) Physical restraints are defined as the following:

Type I—the equipment used to promote the safety of the individual but is not applied directly to their person. Examples: divided doors and totally enclosed cribs.

Type II—the application of a device to the body to promote safety of the individual. Examples: vest devices, soft-tie devices, hand socks, geriatric chairs.

Type III—the application of a device to any part of the body which will inhibit the movement of that part of the body only. Examples: wrist, ankle or leg restraints and waist straps.

         58.43(5) Physical restraints are not to be used to limit resident mobility for the convenience of staff and must comply with life safety requirements. If a resident’s behavior is such that it may result in injury to the resident or others and any form of physical restraint is utilized, it should be in conjunction with a treatment procedure(s) designed to modify the behavioral problems for which the resident is restrained, or as a last resort, after failure of attempted therapy. (I, II)

         58.43(6) Each time a Type II or III restraint is used documentation on the nurse’s progress record shall be made which includes type of restraint and reasons for the restraint and length of time resident was restrained. The documentation of the use of Type III restraint shall also include the time of position change. (II)

         58.43(7) Each facility shall implement written policies and procedures governing the use of restraints which clearly delineate at least the following:

            a.               Physicians’ orders shall indicate the specific reasons for the use of restraints. (II)

            b.               Their use is temporary and the resident will not be restrained for an indefinite amount of time. (I, II)

            c.               A qualified nurse shall make the decision for the use of a Type II or Type III restraint for which there shall be a physician’s order. (II)

            d.               A resident placed in a Type II or III restraint shall be checked at least every 30 minutes by appropriately trained staff. No form of restraint shall be used or applied in such a manner as to cause injury or the potential for injury and provide a minimum of discomfort to resident restrained. (I, II)

            e.               Reorders are issued only after the attending physician reviews the resident’s condition. (II)

            f.                Their use is not employed as punishment, for the convenience of the staff, or as a substitute for supervision or program. (I, II)

            g.               The opportunity for motion and exercise shall be provided for a period of not less than ten minutes during each two hours in which Type II and Type III restraints are employed, except when resident is sleeping. However, when resident awakens, this shall be provided. This shall be documented each time. A check sheet may serve this purpose. (I, II)

            h.               Locked restraints or leather restraints shall not be permitted except in life-threatening situations. Straight jackets and secluding residents behind locked doors shall not be employed. (I, II)

            i.                Nursing assessment of the resident’s need for continued application of a Type III restraint shall be made every 12 hours and documented on the nurse’s progress record. Documentation shall include the type of restraint, reason for the restraint and the circumstances. Nursing assessment of the resident’s need for continued application of either a Type I or Type II restraint and nursing evaluation of the resident’s physical and mental condition shall be made every 30 days and documented on the nurse’s progress record. (II)

            j.                A divided door equipped with a securing device that may be readily opened by personnel shall be considered an appropriate means of temporarily confining a resident in the resident’s room. (II)

            k.               Divided doors shall be of the type that when the upper half is closed the lower section shall close. (II)

            l.                Methods of restraint shall permit rapid removal of the resident in the event of fire or other emergency. (I, II)

            m.              The facility shall provide orientation and ongoing education programs in the proper use of restraints.

         58.43(8) In the case of an intellectually disabled individual who participates in a behavior modification program involving use of restraints or aversive stimuli, the program shall be conducted only with the informed consent of the individual’s parent or responsible party. Where restraints are employed, an individualized program shall be developed by the interdisciplinary team with specific methodologies for monitoring its progress. (II)

            a.               The resident’s responsible party shall receive a written account of the proposed plan of the use of restraints or aversive stimuli and have an opportunity to discuss the proposal with a representative(s) of the treatment team. (II)

            b.               The responsible party must consent in writing prior to the use of the procedure. Consent may also be withdrawn in writing. (II)

         58.43(9) Allegations of dependent adult abuse. Allegations of dependent adult abuse shall be reported and investigated pursuant to Iowa Code chapter 235E and 481—Chapter 52. (I, II, III)

       58.43(10) and 58.43(11) Rescinded IAB 12/11/13, effective 1/15/14.

This rule is intended to implement Iowa Code sections 135C.14, 235B.3(1), and 235B.3(11).

[ARC 0766C, IAB 5/29/13, effective 7/3/13; ARC 1204C, IAB 12/11/13, effective 1/15/14]