<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".06" citation="COMAR 10.22.10.06" title_num="10" subtitle_num="22" chapter_num="10" heading="Use of Restrictive Techniques.">
  <paragraph num="A.">
    <text>The licensee shall ensure that the use of restrictive techniques in any BP:</text>
    <paragraph num="(1)">
      <text>Represents the least restrictive, effective alternative, or the lowest effective dose of a medication; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Is only implemented after other methods have been:</text>
      <paragraph num="(a)">
        <text>Systematically tried, and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Objectively determined to be ineffective.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The licensee shall collect and present objective data to the authorizing licensed health care practitioner to indicate whether the restrictive technique being used is effective in reducing the individual's challenging behavior.</text>
  </paragraph>
  <paragraph num="C.">
    <text>The licensee shall:</text>
    <paragraph num="(1)">
      <text>Convene the team within 5 calendar days after an emergency use of a restrictive technique to review the situation and action taken;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Determine subsequent action include whether the development or modification of a BP is necessary; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Document that the requirements of this regulation have been met.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>The licensee shall ensure that staff do not use:</text>
    <paragraph num="(1)">
      <text>Any method or technique prohibited by law, including aversive techniques;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Any method or technique which deprives an individual of any basic right specified in Health-General Article, §§7-1002—7-1004, Annotated Code of Maryland, except as permitted in COMAR 10.22.04.03A;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Seclusion;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>A room from which egress is prevented; or</text>
    </paragraph>
    <paragraph num="(5)">
      <text>A program which results in a nutritionally inadequate diet.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Staff may not use a restrictive technique:</text>
    <paragraph num="(1)">
      <text>As a substitute for a treatment plan;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>As punishment; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>For convenience.</text>
    </paragraph>
  </paragraph>
</regulation>