# COMAR Title 10 — Maryland Department of Health

## Subtitle 07 — Hospitals

### Chapter 09 — Residents' Bill of Rights: Comprehensive Care Facilities and Extended Care Facilities

#### Regulation .14 Physical and Chemical Restraints.

*COMAR 10.07.09.14*

A. Physical restraints may be used only:

  (1) As an integral part of an individual medical treatment plan;

  (2) If absolutely necessary to protect the resident or others from injury;

  (3) If prescribed by a physician or administered by another health care professional practicing within the scope of their license; and

  (4) If less restrictive alternatives were considered and appropriately ruled out by the physician.

B. Use of Physical Restraints.

  (1) When a facility uses physical restraints, personnel:

    (a) Trained in the use of restraints shall check a resident in restraint at least every 2 hours, and maintain a record of the checks and usage; and

    (b) Shall provide opportunities for motion and exercise during each 2-hour period in which physical restraint is used, and shall monitor the use of the restraint use and maintain a record of it.

  (2) The attending physician shall ensure that treatment plans include provisions for the progressive elimination of physical restraints.

C. Use of Psychopharmacologic Drugs. When a physician prescribes psychopharmacologic drugs for a resident, the resident's clinical records shall contain all of the following documentation:

  (1) A physician's indication that the dosage, duration, indication, and monitoring are clinically appropriate and the reasons why they are clinically appropriate;

  (2) Indication that the resident is being monitored for adverse complications of the drug therapy;

  (3) Confirmation that previous attempts at dosage reduction have been unsuccessful, if applicable;

  (4) Evidence of the resident's subjective or objective improvement, or maintenance or function, while taking the medication;

  (5) Evidence that the resident's decline or deterioration, if applicable, has been evaluated by the interdisciplinary team to determine whether a particular drug, a particular dosage, or duration of therapy may be the cause;

  (6) Evidence of why the resident's age, weight, or other factors would require a unique drug dose, drug duration, indication, or monitoring; or

  (7) Other evidence that substantiates the use of the restraint.