# COMAR Title 10 — Maryland Department of Health

## Subtitle 21 — Behavioral Health Regulations

### Chapter 13 — Use of Quiet Room and Use of Seclusion

#### Regulation .03 Use of Seclusion.

*COMAR 10.21.13.03*

A. Staff authorized under the provisions of Regulation .04C of this chapter may use seclusion:

  (1) Only during an emergency in which the behavior of the patient places the patient or others in serious threat of violence or injury; and

  (2) If ordered by a physician in writing; or

  (3) If at the direction of a registered nurse if a physician's order is obtained within 2 hours of the action.

B. Staff may not use seclusion:

  (1) As a mode or course of treatment;

  (2) As punishment, coercion, discipline, or retaliation;

  (3) For the convenience of staff;

  (4) To prevent damage or destruction to property; or

  (5) To prevent serious disruption of the therapeutic environment.

C. Staff shall conduct seclusion:

  (1) In a humane, safe, and effective manner;

  (2) Without intent to harm or create undue discomfort to the patient; and

  (3) For the shortest possible length of time, regardless of the length of time in the physician's order.

D. Staff authorized under the provisions of Regulation .04C of this chapter may order the use of seclusion only if that staff person, following a clinical evaluation of the patient, determines that:

  (1) The patient's behavior poses an emergency situation; and

  (2) Less restrictive or alternative approaches have been determined to be ineffective to ensure the safety of the patient, staff, or others.

E. The approaches referred to in §D(2) of this regulation may include, but are not limited to:

  (1) Clinical interventions;

  (2) Quiet room;

  (3) Medication or medications;

  (4) Deescalation techniques;

  (5) Trauma-informed care interventions;

  (6) Calling the hospital's response team for assistance; and

  (7) Consulting the patient's care plan for personalized strategies.