<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".12" citation="COMAR 10.21.12.12" title_num="10" subtitle_num="21" chapter_num="12" heading="Quality Assurance.">
  <paragraph num="A.">
    <text>The clinical director or the clinical director's designee shall review daily all uses of restraint and investigate unusual or possibly unwarranted patterns of use.</text>
  </paragraph>
  <paragraph num="B.">
    <text>The physician involved in the restraint may not function in the capacity outlined in §A of this regulation.</text>
  </paragraph>
  <paragraph num="C.">
    <text>A facility shall identify a committee to review periodically, but not less than quarterly, the use of restraint to assure that the standards maintained by the facility are, at a minimum, consistent with this chapter.</text>
  </paragraph>
  <paragraph num="D.">
    <text>Staff who implement orders for restraint:</text>
    <paragraph num="(1)">
      <text>Shall have documented annual training in the proper use of physical restraint and hold including training for special populations which include, but are not limited to, children and the elderly;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Shall have documented annual training in trauma-informed care and demonstrate competency in providing trauma-informed care services; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>May not implement orders for restraint until trained by the facility to do so unless, in an emergency situation, the safety of the patient or others is threatened.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>The facility's chief executive officer or the chief executive officer's designee is responsible for assuring that the restraint devices used in that facility are maintained in accordance with acceptable standards for hygiene and safety.</text>
  </paragraph>
  <paragraph num="F.">
    <text>If seclusion is used in conjunction with restraint, staff shall also comply with COMAR 10.21.13.</text>
  </paragraph>
</regulation>