3.14 – Restrictive Measure, Aversive, Restraint Procedures

At Open Door ICF settings, before implementing a restrictive measure, a referral needs to be sent to either Physical Therapy, Occupational Therapy or Speech. Once the assessment is complete, the IPP/ISP team will meet to discuss the assessment and recommendations. If the team agrees with the ancillary recommendation, consent will be signed by the individual/guardian. 

Once consent is given, the restrictive measure will be presented at Human Rights/Behavior Support for approval.   If approval is needed before the Human Rights/Behavior Support meeting, a poll can be conducted of 2 committee members for interim approval and then brought to the meeting for full approval.

A restrictive measure means a method of last resort that may be used by persons or entities providing specialized services only when necessary to keep people safe and with prior approval by the Human Rights Committee.  Open Door promotes the use of restrictive measures only as a last resort and after all least restrictive measures have been exhausted.

Open Door practices the following uses of aversive/restraints: 

• Manual Restraint.  Manual restraint means use of a hands on method, but never in a prone restraint, to control an identified action by restricting the movement or function of an individual’s head, neck, torso, one or more limbs or entire body, using sufficient force to cause the possibility of injury and includes holding, blocking or disabling an individual’s wheelchair or other mobility device.  An individual in a manual restraint shall be under constant visual supervision by staff.  Manual restraint shall cease immediately once risk of harm has passed.
• Mechanical Restraint: Means use of a device, but never in a prone restraint to control an identified action by restraint an individual’s movement or function, including a device used in any vehicle except a seatbelt of a type found in an ordinary passenger vehicle.  Mechanical restraint shall cease immediately once risk of harm has passed. 
• Chemical Restraint:  means a medication prescribed for the purpose of modifying, diminishing, controlling or altering a specific behavior.  “Chemical restraint” does not include medications prescribed for the treatment of a diagnosed disorder identified in the diagnostic and statistical Manual of mental disorders (fifth edition) or medications prescribed for treatment of a seizure disorder. 
• For medications given prior to medical treatments/appointments to reduce trauma or anxiety, Open Door will ensure that the following are in place:
  • Medical record reflects history anxiety related to specific appointments, treatments (this should remain in individual’s medical chart)
  • The medication order is one that is similarly prescribed for general patients who experience anxiety even outside of the DD population
  • The prescription order clearly identifies the medication name, route, dosage, time to be administered, and any other instructions
  • The guardian/individual provides prior consent for the medication to be given

The above mentioned restrictive measures are generally used for the following:

• Safety
• Behavioral
• Medication Sedation
• Immediate action to maintain health and welfare to individual
• Aversive/Restraint Human Rights Behavior Support Committee Poll

Examples of Restraints for Open Door but are not limited to:

• Safety:  Some individuals have diagnosis that may cause them to have safety issues.  For example a seizure disorder.   In order to maintain their safety, a doctor may write an order for a mechanical restraint, such as a bed alarm or bed rails to use to keep the individual safe.   Whenever this is used,  a Balancing Rights and Safety Form along with a fading plan will be implemented.  Consent will be obtained from the individual/guardian and approval will be needed from Human Rights/Behavior Support Committee.
• Behavioral:   Due to behavioral issues, sometimes it is necessary to use a manual restraint to maintain health and welfare to the individual and others. For example, an individual may have a target behavior of wandering and therefore a wander guard had to be purchased to maintain health and welfare to that individual. This will be included on the Behavior Support Plan as an aversive along with a fading of the aversive. Consent will be obtained from the individual/guardian and approval will be needed from Human Rights/Behavior Support Committee.
• Medication Sedation:  Some individuals find it necessary to be sedated during doctor appointments or medical/dental procedures. In cases where all attempts have been unsuccessful, the use of a chemical restraint may be necessary in order to complete the appointment.  For medications given prior to medical treatments/appointments to reduce trauma or anxiety, Open Door will ensure that the following are in place:
  • Medical record reflects history anxiety related to specific appointments, treatments (this should remain in individual’s medical chart)
  • The medication order is one that is similarly prescribed for general patients who experience anxiety even outside of the DD population
  • The prescription order clearly identifies the medication name, route, dosage, time to be administered, and any other instructions
  • The guardian/individual provides prior consent for the medication to be given
• Immediate Action to maintain health and welfare to individual: Sometimes an Unapproved Behavior Support may be necessary to maintain the health and welfare of an individual. For example,  an individual may place themselves or others in a dangerous situation, such as run out into the street and a manual restraint/escort is needed to maintain health and safety. An incident report needs to be written immediately and MUI needs to be notified of the incident.
• Behavioral Human Rights/Behavior Support poll:  In the event when an individual places themselves or others in danger and there is enough time to poll the HR/BSC, for example, an individual has threatened suicide and it may be necessary to lock up all sharp objects. A HR/BSC poll can be obtained by 2 committee members for interim approval to lock up the sharp objects. The Poll will then be brought to the next HR/BSC meeting for full approval. (Refer to policy 3.09)

Last Revised: 5/20/22