<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".03" citation="COMAR 10.21.13.03" title_num="10" subtitle_num="21" chapter_num="13" heading="Use of Seclusion.">
  <paragraph num="A.">
    <text>Staff authorized under the provisions of Regulation .04C of this chapter may use seclusion:</text>
    <paragraph num="(1)">
      <text>Only during an emergency in which the behavior of the patient places the patient or others in serious threat of violence or injury; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>If ordered by a physician in writing; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>If at the direction of a registered nurse if a physician's order is obtained within 2 hours of the action.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Staff may not use seclusion:</text>
    <paragraph num="(1)">
      <text>As a mode or course of treatment;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>As punishment, coercion, discipline, or retaliation;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>For the convenience of staff;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>To prevent damage or destruction to property; or</text>
    </paragraph>
    <paragraph num="(5)">
      <text>To prevent serious disruption of the therapeutic environment.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Staff shall conduct seclusion:</text>
    <paragraph num="(1)">
      <text>In a humane, safe, and effective manner;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Without intent to harm or create undue discomfort to the patient; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>For the shortest possible length of time, regardless of the length of time in the physician's order.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>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:</text>
    <paragraph num="(1)">
      <text>The patient's behavior poses an emergency situation; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Less restrictive or alternative approaches have been determined to be ineffective to ensure the safety of the patient, staff, or others.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>The approaches referred to in §D(2) of this regulation may include, but are not limited to:</text>
    <paragraph num="(1)">
      <text>Clinical interventions;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Quiet room;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Medication or medications;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Deescalation techniques;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Trauma-informed care interventions;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Calling the hospital's response team for assistance; and</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Consulting the patient's care plan for personalized strategies.</text>
    </paragraph>
  </paragraph>
</regulation>