PRESENTED BY :BEHAVIOR SUPPORT OVERSIGHT

COMMITTEE (BSOC)

Restrictive Measures OverviewPart 1

Resources and Information For Today’s Training

Chapter 51.61DHS 94.10 Guidelines And Requirements For The Use of

Restrictive Measures (DHS, DQA, DLTS) (February 2009).

CCCW Restrictive Measures Policy.

What is a Restrictive measure?

The definition of Restrictive Measures applies to the forms of restraint, isolation, and protective equipment identified below: Manual Restraints Mechanical Restraint Medical Restraint Isolation/Seclusion Protective Equipment Mechanical Support

Relationship of Individual Rights and Restrictive Measures

Mail

Access to phone

Prompt Treatment

Visitors

Storage

Access to funds

Religion

Voting

Medications and treatment

RestraintIsolationSeclusionLeast Restrictive Treatment and Conditions

Categories of Restrictive Measures

Manual Restraints Mechanical RestraintMedical restraintIsolation/SeclusionProtective equipmentMechanical support

What is a restraint?

Any device, garment or physical hold that

Restricts the voluntary movement of a person’s body or access to any part of the body

And cannot be easily removed by the individual

Manual Restraints

“Hands on”, holding limbs or body contingent upon behavior

Restricting or preventing movement

Not longer than 15 continuous minutes

Examples:

Manual Restraint Does Not Include:

Medical restraints.Holding limbs or body to provide functional

movement and positioning.Holding limbs or body to prevent falling.Self protective blocking or passive

redirecting aggressive behavior.Graduated guidance as part of an approved

intervention.

Mechanical Restraint

A device applied to any part of a person’s body contingent upon behavior

Restricts or prevents movement or normal use/functioning of the body part

Cannot be easily removed by the individualCannot impair hearing, vision, or speech

(DHS)

Example:

Medical Restraint

Apparatus or procedure that restricts voluntary free movement

Cannot be easily removed by the individualUsed prior to, during, or subsequent to a

medical procedureOr to protect during the time a medical

condition exists

Example:

Medical Restraint cont. - Short-term Use

MD writes an order for use during the first 10 days. Guardian is notified.

If restraint continues past the initial 10 days then guardian consent is required.

If this occurs regularly or becomes long-term then application for use is required.

Isolation/Seclusion

Involuntary physical or social separation from others by actions of staff

Contingent upon behavior

Example:

Protective Equipment

Device that does not restrict movement but does prevent access

Applied to any part of a person’s body to prevent tissue damage as a result of behavior

Cannot be easily removed by the individual

Example

Mechanical Support

An apparatusProperly aligns a person’s body or helps

maintain balanceDesigned by a qualified professional in

accordance with principles of good body mechanics, concern for circulation, and allow for change in position.

Generally not a restraint, but could be if it meets the definition.

Example:

Exceptional Measures

Specific forms of restraint that are considered highly restrictive and present a higher level of risk

Require an additional level of review- Oversight Committee

Waiving or modifying any process requirement is considered an exceptional measure as well

Exceptional Forms of Manual Restraint

Any form of horizontal restraint Physically forcing a person to lay in a horizontal

position

Takedowns Physically forcing a person to a prone position

on the ground, floor, or mat

Exceptional Forms of Mechanical Restraint

Restraint vests, jackets, body wrapsSeclusionWrist or ankle restraintsRemoval of mobility aidsRestraint chairsBed enclosures

Exceptional form of isolation:

Seclusion

Person is physically set apart from others

Use of locked doors

Emergency

Sudden, unexpected behavior that places the person or others in some danger of injury or

onset of signs/symptoms known to be precursors of such behavior

After two incidents within 6 months no longer is unanticipated

Agency should have a written policy as to who can implement emergency restraint

Emergency cont.

Agency must have a notification process

An MD order is required if the emergency restraint episode exceeds 1 hour

Emergency restraint is a county critical incident reportable event (DDES 2558) or to the MCO Event Recording system.

Example

Frank is non-ambulatory and uses a highly modified wheelchair for proper body alignment. He often kicks his legs out; moves them off the foot rests, or lets them hang behind the foot rests. This has been resolved by providing a strap around each ankle that is in turn strapped down to the footrest holding his foot securely to the rest. The Physical Therapist has written into their evaluation “ankle straps secured to footrests for safety during transportation”. This is repeated in his support plan.

 Is this a restraint?