Patient Request. A patient may request the use of a quiet room and, unless clinically contraindicated, may be granted use of a quiet room. Unless staff terminates use of the quiet room for clinical reasons, the patient may terminate self-initiated use of the quiet room at any time. Staff Request. When staff, permitted by the facility to initiate and terminate use of a quiet room, determine that the use of the quiet room is clinically indicated, staff may request that a patient voluntarily enter into the quiet room. Staff may not coerce a patient into entering the quiet room. When the patient enters the quiet room, staff shall discuss with the patient: The recommended length of stay in the quiet room; The behaviors expected of the patient before and upon return to the milieu; and The primary interventions to be initiated if the use of the quiet room is terminated by the patient before the time recommended by staff or is determined to be ineffective. Staff shall determine the need for removal of any harmful objects in the room or from the patient. If staff determine a need for objects to be removed pursuant to §C of this regulation, staff shall ask the patient, in a nonthreatening manner, to surrender the objects. While a quiet room is in use, the staff shall assure that the quiet room door is not locked or in a position that prevents a patient from exiting the room voluntarily. Observation and Documentation. Staff shall: Be assigned to monitor the patient and the safety of the environment while a patient is in the quiet room; When the quiet room is used as a clinical intervention, observe the patient at least once every 30 minutes and document the observation in the patient's medical record; and At least every 2 hours, evaluate the effectiveness of the outcome and document the clinical rationale for continued use of the quiet room. A physician shall review the use of the quiet room after 6 hours and, if use of the quiet room is continued, at least every 24 hours after that. Use of a quiet room may be terminated at any time: Upon the decision of the patient; or As clinically determined by staff.