Section 481.62.13. Crisis intervention.

       62.13(1) There shall be written policies and procedures concerning crisis intervention. (II) These policies and procedures shall be:

        a.           Directed to maximizing the growth and development of the individual by incorporating a hierarchy of available alternative methods that emphasize positive approaches; (II, III)

        b.           Available in each program area and living unit; (II, III)

        c.           Available to individuals and their families; and (II, III)

        d.           Developed with the participation, as appropriate, of individuals served. (II, III)

       62.13(2) Corporal punishment and verbal abuse (shouting, screaming, swearing, name- calling, or any other activity that would be damaging to an individual’s self-respect) are prohibited by written policy. (II)

       62.13(3) Medication shall not be used as punishment, for the convenience of staff, or as a substitute for a program. Direct care staff shall monitor residents on medication and notify the physician if a resident is too sedated to participate in IPP. (I, II)

       62.13(4) Residents shall not be subjected to mechanical restraint. (I, II)

       62.13(5) There shall be written policies that define the uses of seclusion and physical restraints, designate the staff member(s) who may authorize its use, and establish a mechanism for monitoring and controlling its use. (I, II) Temporary physical restraint and temporary seclusion of residents shall be used only under the following conditions: (I, II)

        a.           An emergency to prevent injury to the resident or to others; or (I, II)

        b.           For crisis intervention but shall not be used for punishment, for the convenience of staff or as a substitution for supervision or program; (I, II) and

        c.           Seclusion may only be used in an RCF/PMI if a variance is granted. When a seclusion room is used, it shall meet the standards set out in 481—subrule 61.5(12). (I, II)

       62.13(6) The physician and QMHP shall be notified immediately of the resident’s need for placement in seclusion and a time-limited order for seclusion obtained from the physician. The order shall be for no more than one hour at a time. If the resident is placed in seclusion longer than one hour, the resident shall be visited and evaluated by the physician or qualified mental health professional before a continuation of the seclusion order can be obtained. If the evaluation is conducted by a QMHP, the physician shall be notified of the resident’s condition and the physician shall see the resident within 24 hours of each incident of seclusion and sign the seclusion order. (I, II)

       62.13(7) If orders for seclusion remain in force for more than a total of 3 hours in a 24-hour period, the facility shall make arrangements for immediate transfer of the resident to a higher level of care. (I, II)

       62.13(8) Standing or PRN orders for seclusion are prohibited. (I, II)

       62.13(9) Written documentation of the above information shall be kept as a part of each resident’s record and the administrator shall be responsible for maintaining a daily record of seclusion usage which shall be kept available for review by the department. (II, III)

       62.13(10) Written documentation shall be kept of each incident of seclusion to minimally include: (II)

        a.           Explanation of less restrictive measures implemented prior to use of seclusion, (I, II)

        b.           Record of visual observation of the resident every ten minutes or more frequently if needed, (I)

        c.           Description of the resident’s activity at the time of observation to include verbal exchange and behavior, (I, II)

        d.           Description of safety procedures taken (removal of dangerous objects, etc.), (I)

        e.           Record of vital signs including blood pressure, pulse and respiration unless contraindicated by resident behavior and reasons documented, (I, II)

        f.            Record of intake of food and fluid, (II, III)

        g.           Record of rest room use, (II, III)

        h.           Record of numbers of hours and minutes in seclusion. (II)

       62.13(11) The facility shall provide training by qualified professionals to the staff on physical restraint and seclusion theory and techniques. (I)

        a.           The facility shall keep a record of above training for review by the department and shall include attendance. (II, III)

        b.           Only staff who have documented training in physical restraint and seclusion theory and techniques shall be authorized to assist with seclusion or physical restraint of a resident. (I)

        c.           Under no circumstances shall a resident be allowed to actively or passively assist in the restraint of another resident. (I)

This rule is intended to implement Iowa Code section 135C.14.