<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".08" citation="COMAR 10.21.12.08" title_num="10" subtitle_num="21" chapter_num="12" heading="Clinical Interventions During Restraint.">
  <paragraph num="A.">
    <text>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.</text>
  </paragraph>
  <paragraph num="B.">
    <text>While the patient is restrained, in order to provide appropriate clinical care, at a minimum, staff clinically trained to do so shall:</text>
    <paragraph num="(1)">
      <text>Keep the patient in full view at all times;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Protect the patient from harm by others;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Closely observe the patient at least every 15 minutes, and document each observation by the observer;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>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:</text>
      <paragraph num="(a)">
        <text>Determining if the patient has any special needs which need attention;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Checking circulation of the extremities restrained;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Adjusting the restraint; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Realigning the body or massaging the extremities restrained, or both;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>Unless contraindicated by circumstances as assessed and documented by a physician or registered nurse, offer or provide the following:</text>
      <paragraph num="(a)">
        <text>Full range of motion, every 2 hours;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Toilet facilities, at least every 2 hours;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Bathing and oral hygiene, at least once during a 24-hour period;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Meals, at the regularly scheduled hours and under the supervision of nursing personnel; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Fluids, at least every 2 hours; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>As clinically indicated, record temperature, pulse, blood pressure, and respirations.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>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.</text>
  </paragraph>
  <paragraph num="D.">
    <text>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.</text>
  </paragraph>
</regulation>