# COMAR Title 10 — Maryland Department of Health

## Subtitle 21 — Behavioral Health Regulations

### Chapter 12 — Use of Quiet Room and Use of Restraint

#### Regulation .08 Clinical Interventions During Restraint.

*COMAR 10.21.12.08*

A. Regardless of the physical setting in which the patient is placed, at a minimum, one staff member shall be assigned continuously while the patient is in a category I restraint.

B. While the patient is restrained, in order to provide appropriate clinical care, at a minimum, staff clinically trained to do so shall:

  (1) Keep the patient in full view at all times;

  (2) Protect the patient from harm by others;

  (3) Closely observe the patient at least every 15 minutes, and document each observation by the observer;

  (4) Unless contraindicated by circumstances as assessed and documented by a physician or registered nurse, at least hourly, make and document personal contact with the patient for the purpose of:

    (a) Determining if the patient has any special needs which need attention;

    (b) Checking circulation of the extremities restrained;

    (c) Adjusting the restraint; and

    (d) Realigning the body or massaging the extremities restrained, or both;

  (5) Unless contraindicated by circumstances as assessed and documented by a physician or registered nurse, offer or provide the following:

    (a) Full range of motion, every 2 hours;

    (b) Toilet facilities, at least every 2 hours;

    (c) Bathing and oral hygiene, at least once during a 24-hour period;

    (d) Meals, at the regularly scheduled hours and under the supervision of nursing personnel; and

    (e) Fluids, at least every 2 hours; and

  (6) As clinically indicated, record temperature, pulse, blood pressure, and respirations.

C. At least once every 2 hours, a physician or registered nurse shall assess the appropriateness of continuing the restraint and document the factors supporting the assessment in the patient's medical record.

D. When the patient's behavior no longer places the patient or others in serious threat of violence or injury, the patient shall be released from restraint.