THERAPEUTIC RESTRAINTS (USE OF)
Authority, Purpose and Policy
(1) Authority: The authority for this rule is granted to the Director of the Department of Corrections in accordance with ORS 179.040, 423.020, 423.030 & 423.075
(2) Purpose: The purpose of this rule is to provide guidance and direction to staff responsible to assess, administer and evaluate the use of therapeutic restraints for medical or mental health treatment.
(a) It is the policy of the Department of Corrections to authorize the use of therapeutic restraints in the uses specified in this rule. In those circumstances where therapeutic restraints are authorized, the type, the amount and manner are further specified within this rule;
(b) The use of therapeutic restraints is authorized by the Director through the verbal or written order of a physician.
(1) Clinical Record: The record of mental health treatment provided to an inmate. This record is maintained as part of the inmate's individual medical record.
(2) Inmate: Any person under the supervision of the Department of Corrections who is not on parole, probation or post-prison supervision status.
(3) Therapeutic Restraint: A type of restraint applied to an inmate for medical or mental health treatment and designed to limit an inmate's movements.
(1) Therapeutic restraints shall be used to control a mentally disordered inmate only in an emergency. An emergency exists when, because of an inmate's behavior:
(a) There is a substantial likelihood of immediate harm to the inmate or others in the facility; or
(b) There is a substantial likelihood of significant property damage; or
(c) Less restrictive measures are deemed ineffective to manage behavior.
(2) Therapeutic restraints shall only be applied by staff who have been trained in the use and application of such restraints.
(3) The kinds of restraints that may be used for therapeutic purposes include leather, rubber or cloth restraints for the arms, legs and upper torso.
(4) Devices used in the course of medical care which are not subject to this procedure include:
(a) Mechanisms which are usually and customarily employed during medical, surgical or diagnostic procedures (body restraint during surgery, arm restraint during intravenous administration, restraint during radiological procedures).
(b) Mechanisms which are used during patient care to provide protection, postural support or to assist with bodily function (bed rails, tabletop chairs, soft chest restraints, orthopedic appliances, wheelchairs).
(1) Therapeutic restraint shall be applied only upon the verbal or written order of a physician. In the absence of a physician, a registered nurse may authorize application of therapeutic restraint for a period not to exceed one hour. The nurse shall document the specific behavior which required application of therapeutic restraint in the inmate's clinical record.
(2) A physician shall personally assess the inmate prior to or within three hours following application of therapeutic restraint to assess the inmate and evaluate the appropriateness of the use of therapeutic restraint.
(3) Any evaluation of the appropriateness of the use of therapeutic restraint by a nurse and/or physician shall include consideration of the following:
(a) The inmate's behavior;
(b) The need to protect staff and others in the facility;
(c) The inmate's present physical ability to engage in violent or destructive behavior;
(d) The inmate's response to various methods of control;
(e) The risk or degree of physical or psychological harm and discomfort that accompanies the use of therapeutic restraints; and
(f) The risk or degree of interference with the inmate's treatment program, if any.
(4) The physician shall document the following in the inmate's clinical record:
(a) The specific behavior which required application of therapeutic restraint;
(b) The inmate's response to therapeutic restraint; and
(c) The reason the application was appropriate and the extent to which less restrictive measures were inadequate.
(1) Any order authorizing use of therapeutic restraint expires after 12 hours.
(2) A physician may renew the order for a second 12-hour period.
(3) If therapeutic restraint is necessary for more than 24 consecutive hours, a second consulting physician must approve the order.
(1) An inmate will be released from therapeutic restraint by the officer-in-charge or clinical staff as soon as it is reasonable to believe the behavior authorizing use of therapeutic restraint will not immediately resume.
(2) Therapeutic restraint shall be terminated when two waking hours have passed during which the inmate has remained calm.
Condition and Observation
(1) To the extent possible without endangering the inmate, staff or others in the facility, inmates in therapeutic restraint shall be:
(a) Offered fluids if capable of sitting up or laying on the side once every hour while awake or upon request;
(b) Offered the use of a toilet, bedpan or urinal once every hour while awake or upon request;
(c) Offered regular meals and the opportunity to maintain personal hygiene immediately before and after each meal as appropriate;
(d) Provided an opportunity to have exercise of at least ten minutes during each two hours of restraint. (These opportunities apply only during non-sleeping hours from 6:00 a.m. to 9:00 p.m.);
(e) Appropriately clothed which at a minimum includes underclothes, stockings and to be covered with a sheet.
(2) Within 30 minutes of the application of therapeutic restraint, an inmate will be medically examined and treated as necessary by a health care employee. This examination and any treatment rendered shall be documented in the inmate's clinical record.
(3) An inmate in therapeutic restraint shall be observed by correctional staff at least every 15 minutes. These observations shall be documented in the inmate's clinical record.
(4) A registered nurse shall observe and evaluate an inmate's condition not less than once every two hours. Each observation and evaluation shall be documented in the clinical record.
(1) Any application of therapeutic restraint must be reported to the Director or designee within one working day of such application.
(2) The Director or designee will review and evaluate the appropriateness of each application of therapeutic restraint at least quarterly and prepare a written report summarizing the conclusion.