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<regulation prefix="Regulation" num=".02" citation="COMAR 10.21.12.02" title_num="10" subtitle_num="21" chapter_num="12" heading="Definitions.">
  <paragraph num="A.">
    <text>In this chapter, the following terms have the meanings indicated.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Terms Defined.</text>
    <paragraph num="(1)">
      <text>Category I Restraint.</text>
      <paragraph num="(a)">
        <text>“Category I restraint” means a device identified by the facility which limits a patient's mobility to the extent that the patient would not be able to independently reposition himself or herself or would otherwise be rendered helpless in an emergency.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>“Category I restraint” includes, but is not limited to, four-point restraints.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>“Category II restraint” means any device which is not considered by the facility as a category I restraint and includes, but is not limited to, mittens and vests.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>“Chief executive officer (CEO)” means the individual responsible for the overall management of a facility.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>“Child” means an individual younger than 12 years old.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>“Clinical director” means the psychiatrist in charge of the clinical care of all psychiatric patients in the facility.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>“Emergency situation” means a situation in which a patient's behavior poses a serious and imminent danger to the physical safety of self or others.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>“Facility” means any public or private hospital, clinic, or other institution that provides or purports to provide treatment or other services for a mental disorder, except an acute general hospital that does not have a separately identified inpatient psychiatric service.</text>
    </paragraph>
    <paragraph num="(8)">
      <text>“Full view” means the unobstructed view by the assigned staff of a restrained patient.</text>
    </paragraph>
    <paragraph num="(9)">
      <text>“Patient” means an individual receiving services for a mental disorder in a facility and includes any student receiving care and treatment in that facility.</text>
    </paragraph>
    <paragraph num="(10)">
      <text>“Physician” means an individual who is authorized to practice medicine under Health Occupations Article, Title 14, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(11)">
      <text>“Protective device” means any adaptive or assistive device or devices which restrict the movement of the whole or a portion of a patient's body for the purpose of preventing unintentional harm to self or others or which are used for promoting or maintaining normative body functions.</text>
    </paragraph>
    <paragraph num="(12)">
      <text>Prone Restraint.</text>
      <paragraph num="(a)">
        <text>“Prone restraint” means restricting the free movement of all or a portion of a patient’s body through the use of physical force or mechanical devices while the patient is in a prone position.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>“Prone restraint” does not mean a technique for transitioning a patient to a restraint position that involves momentarily placing the individual face down.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(13)">
      <text>“Quiet room” means an unlocked room that patients are not physically prevented from leaving, which is designated for patients' voluntary use to allow them time out of the company of other patients.</text>
    </paragraph>
    <paragraph num="(14)">
      <text>“Registered nurse” means an individual who is licensed to practice registered nursing under Health Occupations Article, Title 8, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(15)">
      <text>Restraint.</text>
      <paragraph num="(a)">
        <text>“Restraint” means:</text>
        <paragraph num="(i)">
          <text>Any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move their arms, legs, body, or head freely; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>A drug or medication when it is used as a restriction to manage the patient’s behavior or restrict the patient’s freedom of movement and is not a standard treatment or dosage for the patient’s condition.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>“Restraint” does not include a helmet when used as a sole form of restraint or a protective device.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(16)">
      <text>“Seclusion” means the involuntary confinement of a patient under the direction of a physician or registered nurse alone in a room which a patient is physically prevented from leaving.</text>
    </paragraph>
    <paragraph num="(17)">
      <text>“Trauma-informed care” means mental health treatment that includes:</text>
      <paragraph num="(a)">
        <text>An appreciation for the high prevalence of trauma experienced by individuals receiving mental health services;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>An understanding of the neurological, biological, psychological, and social effects of trauma and violence, including sexual abuse and exploitation, on an individual; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>An understanding of the environment, practices, and treatments that may need to be modified to address trauma issues.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(18)">
      <text>“Treatment team” means the patient's treatment team as defined in COMAR 10.21.03.02C.</text>
    </paragraph>
  </paragraph>
</regulation>