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NORTH DAKOTA ADMINISTRATIVE CODE
TITLE 75. DEPARTMENT OF HUMAN SERVICES
ARTICLE 3. COMMUNITY SERVICES
CHAPTER 17. PSYCHIATRIC RESIDENTIAL TREATMENT FACILITIES FOR CHILDREN
Date:
08/31/2009
Document:
75-03-17-06. Special treatment procedures.
A facility shall have written procedures on special treatment procedures. Special treatment procedures must not be used for punishment, for the convenience of staff, or as substitute for therapeutic programming. The facility shall provide education to the children, providing instructions on alternative behaviors that would have allowed the staff to avoid the use of special treatment procedures. Physicians shall review the use of special treatment procedures.
1. Timeout. Use of timeout procedures must be supervised by staff at all times, and appropriate entries must be documented in the child's file.
2. Physical escort. Use of physical escort procedures shall be supervised by staff at all times and appropriate entries shall be documented in the child's file.
3. Physical restraints.
a. Restraints are imposed only in emergency circumstances and only to ensure the immediate physical safety of the child, a staff member, or others and less restrictive interventions have been determined to be ineffective. The health, safety, and well-being of the children cared for and treated in the facility must be properly safeguarded;
b. All safety holds must be applied by staff trained in the use of safety holds; and
c. The facility staff shall have established protocols that require:
(1) Entries made in the child's file as to the date, time, staff involved, reasons for the use of, and the extent of physical restraints;
(2) Timely notification within twenty-four hours of the individual who may lawfully act on behalf of the child; and
(3) Face-to-face assessment of children in restraint must be completed by a physician, registered nurse, or other licensed health care professional or practitioner who is trained in the use of safety, emergency interventions. The face-to-face assessment must include assessing the mental and physical well-being of the child. The face-to-face assessment must take place as soon as possible, but in no case later than one hour after the initiation of restraint or seclusion.
4. Seclusion. Seclusion may be imposed only in emergency circumstances and only to ensure the immediate physical safety of the child, a staff member, or others and after less restrictive interventions have been determined to be ineffective. If seclusion is indicated, the facility shall ensure that:
a. The proximity of the staff allows for visual and auditory contact with the child at all times and includes assessments every fifteen minutes;
b. All nontherapeutic objects are removed from the child's presence;
c. All fixtures within the room are tamperproof, with switches located outside the room;
d. Smoke-monitoring or fire-monitoring devices are an inherent part of the seclusion room;
e. Mattresses are security mattresses of fire-resistant material;
f. The room is properly ventilated;
g. Timely notification within twenty-four hours of the individual who may lawfully act on behalf of the child;
h. A child under special treatment procedures is provided the same diet that other children in the facility are receiving;
i. No child remains in seclusion:
(1) For more than four hours in a twenty-four-hour period; and
(2) Without physician approval;
j. Seclusion is limited to the maximum timeframe per episode for fifteen minutes for children aged nine and younger and one hour for children aged ten and older;
k. Physicians shall review the use of seclusion procedures; and
l. Face-to-face assessment of children in seclusion is completed by a physician, registered nurse, or other licensed health care professional or practitioner who is trained in the use of safety, emergency interventions. The face-to-face assessment must include assessing the mental and physical well-being of the child. The face-to-face assessment must take place as soon as possible, but in no case later than one hour after the initiation of restraint or seclusion.
5. Following each use of seclusion, a debriefing must be conducted within twenty-four hours that includes appropriate personnel and the child and:
a. Evaluates and documents in the child's file the well-being of the child served and identifies the need for counseling or other services related to the incident;
b. Identifies antecedent behaviors and modifies the individual treatment plan as appropriate; and
c. Analyzes how the incident was handled and identifies needed changes to procedures or staff training, or both.
6. Special treatment procedure training. Each facility must have a specific training in the use of physical restraints and seclusion, which includes training on the needs and behaviors of the population served, relationship building, alternatives to restraint and seclusion, de-escalation methods, conflict resolution, thresholds for restraints and seclusion, the physiological and psychological impact of restraint and seclusion, monitoring physical signs of distress and obtaining medical assistance, legal issues, position asphyxia, escape and evasion techniques, time limits, the process for obtaining approval for continuation of restraints and seclusion, documentation, debriefing techniques, and investigation for injuries and complaints.
7. Reporting requirement for serious injury or death.
a. Each facility shall notify the department of each death that occurs at each facility.
b. The report must include the name of the child.
c. The report must be provided no later than twenty-four hours after the time of the child's death.
d. The report must contain information on the use of seclusion or restraints as related to the child.
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