<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".23" citation="COMAR 10.12.04.23" title_num="10" subtitle_num="12" chapter_num="04" heading="Use of Restraints.">
  <paragraph num="A.">
    <text>Policy and Procedures. The center shall have a policy and procedure on the use of any device or medication for the specific purpose of restricting the participant's freedom of motion or movement within the center.</text>
  </paragraph>
  <paragraph num="B.">
    <text>A participant has the right to be free of restraints used in violation of this chapter</text>
  </paragraph>
  <paragraph num="C.">
    <text>Improper Use of Chemicals or Drugs. Chemicals or drugs may not be used for participants in the following ways:</text>
    <paragraph num="(1)">
      <text>In excessive dose, including duplicate drug therapy;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>For excessive duration, without adequate monitoring;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Without adequate indications for its use; or</text>
    </paragraph>
    <paragraph num="(4)">
      <text>In the presence of adverse consequences which indicate the dose should be reduced or discontinued.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Improper Use of Physical Restraints. Participants may not be physically restrained:</text>
    <paragraph num="(1)">
      <text>For discipline or convenience; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>If a restraint is not ordered by a physician to treat the participant's symptoms or medical conditions.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Restraint Orders.</text>
    <paragraph num="(1)">
      <text>All restraints shall be ordered by a physician and shall specify:</text>
      <paragraph num="(a)">
        <text>The purpose of the restraint;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The type of restraint to be used; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The length of time the restraint shall be used.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>A participant may not have an as-needed restraint order.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Orders for the use of a restraint shall be time specific.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>A participant may not remain in a restraint for more than 2 hours without a change in position and toileting opportunity.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>If an order for the use of a restraint is to be continued, the order shall be renewed at least every 7 days by a physician.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>The health care provider shall provide training to staff in the appropriate use of the restraint ordered by the physician.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>The program shall notify the participant's family or the participant's representative each time a restraint is used.</text>
  </paragraph>
</regulation>