Serious Emotional Disturbances. A facility may not accept or keep patients who destroy property or are dangerous to themselves or others, or who have acute symptoms of mental illness. Action to Be Taken if a Patient Becomes Actively Disturbed. The following action shall be taken: If a patient becomes actively disturbed, the personal physician shall be notified immediately. A restraint may be used only if all of the following conditions are met: Failure to use a restraint or restraints is likely to endanger the health or safety of the patient or others; There is a written physician's order for the use of the restraint or restraints, which shall comply with the following requirements: The physician's written order for the restraint or restraints shall be for a specified maximum period of time, not to exceed 24 hours. The necessity for the use of the restraint or restraints shall be documented, and The frequency of patient observations by licensed personnel on not less than an hourly basis during the period of time that the restraint or restraints or the effects of the restraint or restraints are present shall be indicated; Appropriate documentation by licensed personnel shall be recorded in the clinical record; The facility may not re-impose a restraint or restraints except upon the written order of a physician who has personally observed the patient since the previous restraint or restraints order was imposed. A restraint or restraints may not be ordered PRN. If a physician is not immediately available, a registered nurse may authorize the use of a physical restraint or restraints for a period not to exceed 4 hours in any 30-day period. Licensed personnel shall observe the patient hourly. The patient shall be seen by a physician if the restraint or restraints are to be applied for more than the initial 4-hour period. Unusual Occurrences. The administrator of the nursing home shall immediately report to the local health department and the Department the occurrence of: Infectious disease; Poisoning; Internal emergency or disaster; External emergency or disaster, Any symptomatic condition of importance to public health that affects the nursing home; or Any other serious occurrence that threatens the welfare, safety, or health of any resident. The administrator of the nursing home shall be responsible for ensuring that appropriate procedures and reporting are carried out for all reportable infections. An occurrence of a confirmed or suspected infection shall be reported and acted on in accordance with COMAR 10.06.01 and COMAR 10.15.03.