Definitions, Seclusion and Restraint for Behavior Management Purposes

DEPARTMENT OF CHILDREN AND FAMILY SERVICES
Mental Health Program

RULE NO: RULE TITLE
65E-20.002: Definitions
65E-20.014: Seclusion and Restraint for Behavior Management Purposes

NOTICE OF CHANGE

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 35 No. 35, September 4, 2009 issue of the Florida Administrative Weekly.

November 16, 2009

Proposed Revisions to 65E-20 Forensic Client Services Act Regulation

65E-20.002 Definitions.

(1) No change.

(2) Advanced Registered Nurse Practioner: as defined in Section 464.003(7), Florida Statutes.

(2) through (12) renumbered (3) through (13) No change.

(10) Restraint: for behavior management purposes is defined in Section 916.106(14)(a), Florida Statutes. A drug used as a restraint is defined in Section 916.106(14)(b), Florida Statutes. Physically holding a person during a procedure to forcibly administer psychotropic medication is a physical restraint. It is the intent of the legislature to minimize and achieve an on-going reduction in the use of restraint.

(11) Seclusion: for behavior management purposes is defined in Section 916.106(16), Florida Statutes. It is the intent of the legislature to minimize and achieve an on-going reduction in the use of seclusion.

(14) Walking Restraint: a type of restraint device that allows an individual limited mobility but still prevents harm to self or others. It is intended as a less restrictive form of restraint (also referred to as an “ambulatory” restraint).

Rulemaking Specific Authority 916,1093, 916.1093(2) FS. Law Implemented 916.106, 916.106(14), 916.106(16) FS. History–New 9-29-86, Amended 7-1-96, Formerly 10E-20.002, Amended_______.

 

Florida Administrative Code 65E-20 is amended by creating 65E-20.014:

65E-20.014 Seclusion and Restraint for Emergency Behavior Management Purposes.

(1) General Standards.

(a) through (b) No change.

(c) Seclusion or restraint shall be employed only in emergency situations when necessary to prevent an individual from seriously injuring self or others, and less restrictive techniques have been tried and failed, or it has been clinically determined that the danger is of such immediacy that less restrictive techniques cannot be safely applied.

(c) Seclusion or restraint shall be employed:

1. Only in emergency situations;

2. When necessary to prevent an individual from seriously injuring self or others; and

3. Less restrictive techniques have been tried and failed, or it has been clinically determined that the danger is such that less restrictive techniques cannot be safely applied.

(d) through (l) No change.

(m) Seclusion and restraint may not be used simultaneously for children less than 18 years of age. For adults age 18 and over individuals over the age of 18, simultaneous seclusion and restraint is only permitted if the individual is continually monitored face-to-face by an assigned, trained staff member or if the individual is continually monitored by trained staff using both audio and video equipment. Staff providing this monitoring must be in close proximity to the individual.

(3) Prior to the Implementation of Seclusion or Restraint.

(a) Prior intervention shall include individualized therapeutic actions identified in a personal safety plan that address individual triggers leading to psychiatric crisis. Recommended form CF-MH 3124, Feb. 05, “Personal Safety Plan,” which is incorporated herein by reference, may be used for the purpose of guiding individualized techniques. Recommended form CF-MH 3124 may be accessed from the department’s website at “http://www.dcf.state.fl.us/mentalhealth/laws.”

(7) Reporting.

(a) All civil and forensic state mental health treatment facilities serving individuals committed pursuant to Chapter 916, F.S., are required to report each seclusion and restraint event to the Department of Children and Families. This reporting shall be done electronically using the Department’s web-based application, either directly via the data input screens, or indirectly via the File Transfer Protocol batch process. The required reporting elements include: provider tax identification number; individual’s social security number and identification number; date and time the seclusion or restraint event was initiated; discipline of the individual ordering the seclusion or restraint; discipline of the individual implementing the seclusion or restraint; reason seclusion or restraint was initiated; type of restraint used; whether significant injuries were sustained by the individual; and date and time seclusion or restraint was terminated. Facilities shall report seclusion and restraint events to the Department on a monthly basis. Events that result in death or significant injury, either to a staff member or individual, shall be reported to the department’s web-based system as required by the department. The purpose of collecting protected health information, such as social security number, is to uniquely identify each person served for treatment, payment, and health care operation as authorized by the HIPAA privacy and security standards, as referenced in 45 CFR 164.506 in accordance with department operating procedures and must also be reported according to the department’s incident reporting procedure.

(b) All facilities that are subject to the Conditions of Participation for Hospitals, 42 Code of Federal Regulations, part 482, under the Centers for Medicare and Medicaid Services (CMS), must report to CMS any death that occurs in the following circumstances:

1. While an individual is restrained or secluded;

2. Within 24 hours after release from seclusion or restraint; OR

3. Within one week after seclusion or restraint, where it is reasonable to assume that use of the seclusion or restraint contributed directly or indirectly to the individual’s death.

Each death described in (7)(b) shall be reported to CMS by telephone no later than the close of business the next business day following knowledge of the individuals’ death. A report shall simultaneously be submitted to the Director of Mental Health/Designee in the Mental Health Program Office Headquarters in Tallahassee, FL. The address is: 1317 Winewood Blvd., Tallahassee, FL 32399-0700. Facilities that are not required to report these deaths to CMS shall report the death to the Director of Mental Health/Designee in the Mental Health Program Office Headquarters at the address above to the department in accordance with Departmental operating procedures.

Rulemaking Specific Authority 916.1093(2) FS. Law Implemented 916.105(4), 916.107(4)(b), 916.1093(2) FS. History–New________.