Section 330.1150  Emergency Use of Physical Restraints  


a)         If a resident needs emergency care, physical restraints may be used for brief periods to permit treatment to proceed unless the facility has notice that the resident has previously made a valid refusal of treatment in question.  (Section 2-106(c) of the Act)


b)         For this Section only "emergency care" means the unforeseen need for immediate treatment inside or outside the facility that is necessary to:


1)         save the resident's life;


2)         prevent the resident from doing serious mental or physical harm to himself/herself; or


3)         prevent the resident from injuring another individual.


c)         If a resident needs emergency care and other less restrictive interventions have proved ineffective, a physical restraint may be used briefly to permit treatment to proceed.  The attending physician shall be contacted immediately for orders.  If the attending physician is not available, the facility's advisory physician or medical director shall be contacted. If a physician is not immediately available, a nurse with supervisory responsibility may approve, in writing, the use of physical restraints.  A confirming order, which may be obtained by telephone, shall be obtained from the physician as soon as possible, but no later than within eight hours.  The effectiveness of the physical restraint in treating medical symptoms or as a therapeutic intervention and any negative impact on the resident shall be assessed by the facility throughout the period of time the physical restraint is used.  The resident must be in view of a staff person at all times until either the resident has been examined by a physician or the physical restraint is removed.  The resident's needs for toileting, ambulation, hydration, nutrition, repositioning, and skin care must be met while the temporary restraint is being used.


d)         The emergency use of a physical restraint must be documented in the resident's record, including:


1)         the behavior incident that prompted the use of the physical restraint;


2)         the date and times the physical restraint was applied and released;


3)         the name and title of the person responsible for the application and supervision of the physical restraint;


4)         the action by the resident's physician upon notification of the physical restraint use;


5)         the new or revised orders issued by the physician;


6)         the effectiveness of the physical restraint in treating medical symptoms or as a therapeutic intervention and any negative impact on the resident; and


7)         the date of the scheduled care planning conference or the reason a care planning conference is not needed, in light of the resident's emergency need for physical restraints.


e)         A physical restraint may be applied only by staff trained in the application of the particular type of restraint.  (Section 2-106(d) of the Act)


f)         Whenever a period of use of a physical restraint is initiated, the resident shall be advised of his or her right to have a person or organization of his or her choosing, including the Guardianship and Advocacy Commission, notified of the use of the physical restraint.  A period of use of a physical restraint is initiated when a physical restraint is applied to a resident for the first time. A recipient who is under guardianship may request that a person or organization of his or her choosing be notified of the physical restraint, whether or not the guardian approved the notice.  If the resident so chooses, the facility shall make the notification within 24 hours, including any information about the period of time that the physical restraint is to be used.  Whenever the Guardianship and Advocacy Commission is notified that a resident has been restrained, it shall contact the resident to determine the circumstances of the restraint and whether further action is warranted.  (Section 2-106(e) of the Act) If the resident requests that the Guardianship and Advocacy Commission be contacted, the facility shall provide the following information in writing to the Guardianship and Advocacy Commission:


1)         the reason the physical restraint was needed;


2)         the type of physical restraint that was used;


3)         the interventions utilized or considered prior to physical restraint and the impact of these interventions;


4)         the length of time the physical restraint was to be applied; and


5)         the name and title of the facility person who should be contacted for further information.


g)         Whenever a physical restraint is used on a resident whose primary mode of communication is sign language, the resident shall be permitted to have his or her hands free from restraint for brief periods each hour, except when this freedom may result in physical harm to the resident or others. (Section 2-106(f) of the Act)


h)         No form of seclusion shall be permitted.


(Source:  Added at 20 Ill. Reg. 12160, effective September 10, 1996)