A facility shall: Have a written policy specifying the method used to ensure that a patient whose primary language or method of communication is nonverbal is able to effectively communicate distress during a physical restraint or hold; and Ensure that all staff at the facility who are authorized to participate in a physical restraint or hold of a patient are trained in the method specified in the written policy in accordance with §A(1) of this regulation. A physician who is responsible either for the care of the patient or for assessment of the appropriateness of a restraint or, when the appropriate physician is not readily available to assess the patient, a registered nurse shall conduct a clinical evaluation of the patient to determine whether an emergency situation is present. Before using restraint, the physician or registered nurse shall assess whether less restrictive or alternative approaches have been determined to be ineffective to ensure the safety of the patient, staff, or others. When a physician, as identified in §B of this regulation, is immediately available, the physician shall be responsible for determining a patient's need for a restraint and make the decision whether to restrain. Authorization in the Absence of a Physician. When a physician, as identified in §B of this regulation, is not immediately available, a registered nurse shall determine a patient's need for restraint and may initiate and direct the use of restraint. Within 2 hours of the implementation of the restraint, a physician shall give a written or verbal order for any restraint initiated by a registered nurse and, at that time, shall make the clinical determination to continue or to discontinue the restraint.