<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".18" citation="COMAR 10.07.22.18" title_num="10" subtitle_num="07" chapter_num="22" heading="Restraint or Seclusion.">
  <paragraph num="A.">
    <text>A hospice house shall develop a policy and procedure related to restraint and seclusion.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Relevant staff shall be trained in accordance with the facility’s policy and procedure related to restraint and seclusion.</text>
  </paragraph>
  <paragraph num="C.">
    <text>Patients have the right to be free from restraint or seclusion of any form which are imposed as a means of coercion, discipline, convenience, or retaliation by staff.</text>
  </paragraph>
  <paragraph num="D.">
    <text>Restraint or seclusion may only be imposed to ensure the immediate physical safety of the patient, a staff member, or others and shall be discontinued at the earliest possible time.</text>
  </paragraph>
  <paragraph num="E.">
    <text>The type or technique of restraint or seclusion used shall be the least restrictive intervention that will be effective to protect the patient, a staff member, or others from harm.</text>
  </paragraph>
  <paragraph num="F.">
    <text>The use of restraint or seclusion shall be:</text>
    <paragraph num="(1)">
      <text>In accordance with a written modification to the patient’s plan of care; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Implemented in accordance with safe and appropriate restraint and seclusion techniques as determined by hospice policy in accordance with applicable laws.</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>All restraints shall be ordered by a physician and shall specify:</text>
    <paragraph num="(1)">
      <text>The purpose of the restraint;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The type of restraint to be used; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The length of time the restraint shall be used.</text>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>Restraint and seclusion orders may not be on an as-needed basis.</text>
  </paragraph>
  <paragraph num="I.">
    <text>A patient may not remain in a restraint for more than 2 hours without a change in position and toileting opportunity.</text>
  </paragraph>
  <paragraph num="J.">
    <text>The patient’s primary hospice nurse or hospice nurse on call and hospice medical director or physician designee shall be consulted as soon as possible after the implementation of any restraint or seclusion to, as applicable:</text>
    <paragraph num="(1)">
      <text>Review and modify the plan of care; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Determine if the hospice house is an appropriate setting for the patient at this time.</text>
    </paragraph>
  </paragraph>
  <paragraph num="K.">
    <text>The program shall notify the patient’s family or the patient’s representative each time a restraint is used.</text>
  </paragraph>
</regulation>