<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".06" citation="COMAR 10.21.12.06" title_num="10" subtitle_num="21" chapter_num="12" heading="Placement of Patient in Restraint.">
  <paragraph num="A.">
    <text>When possible, staff shall advise a patient, in a nonthreatening manner, that continuation of a specific behavior may result in the use of restraint.</text>
  </paragraph>
  <paragraph num="B.">
    <text>When a physician or registered nurse determines that the use of a restraint is appropriate, staff involved shall make a reasonable effort to verbally persuade the patient to be cooperative with the restraint.</text>
  </paragraph>
  <paragraph num="C.">
    <text>Staff shall apply a restraint only in accordance with the facility's policy and procedure manual.</text>
  </paragraph>
  <paragraph num="D.">
    <text>For the patient's safety and the safety of others:</text>
    <paragraph num="(1)">
      <text>Staff shall place the patient in the restraint in as dignified a manner as the situation permits, using the least amount of physical force necessary;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>As necessary, additional staff shall participate in the placement of a patient in restraint;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The patient shall be free from subject prone restraint; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The patient shall be free from a restraint that:</text>
      <paragraph num="(a)">
        <text>Applies pressure to the patient’s back;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Obstructs the airway of the patient or impairs the patient’s ability to breathe;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Obstructs a staff member’s view of the patient’s face; or</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Restricts the patent’s ability to communicate distress.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Unless a physician or registered nurse determines that it is unsafe to do so, staff shall permit the patient to wear all or a portion of the patient's own clothes or another form of attire.</text>
  </paragraph>
  <paragraph num="F.">
    <text>Staff shall search the patient for potentially harmful objects.</text>
  </paragraph>
  <paragraph num="G.">
    <text>If staff determine a need for objects to be removed pursuant to §F of this regulation, staff shall ask the patient, in a nonthreatening manner, to surrender the objects.</text>
  </paragraph>
  <paragraph num="H.">
    <text>Unless contraindicated for safety reasons, staff shall permit the patient to wear eyeglasses, hearing aids, dentures, or prosthetic devices.</text>
  </paragraph>
  <paragraph num="I.">
    <text>When placing a patient in a restraint, staff shall inspect each restraining device and ensure that each restraining device is safely and securely applied.</text>
  </paragraph>
  <paragraph num="J.">
    <text>As necessary, staff shall ensure that each restraint is padded to provide appropriate protection for the patient.</text>
  </paragraph>
</regulation>