.38 Restraints.

A. The resident has the right to be free of restraints used in violation of this chapter.

B. A protective device as defined in Regulation .02B(66) of this chapter is not considered a restraint.

C. Improper Use of Chemicals or Drugs. Chemicals or drugs may not be used for residents in the following ways:

(1) In excessive dose, including duplicate drug therapy;

(2) For excessive duration, without adequate monitoring;

(3) Without adequate indications for its use; or

(4) In the presence of adverse consequences which indicate the dose should be reduced or discontinued.

D. Improper Use of Physical Restraints. Residents may not be physically restrained:

(1) For discipline or convenience; or

(2) If a restraint is not ordered by a physician to treat the resident’s symptoms or medical conditions.

E. Restraint Orders.

(1) Any restraint shall be ordered by a physician and shall specify:

(a) The purpose of the restraint;

(b) The type of restraint to be used; and

(c) The length of time the restraint shall be used.

(2) A resident may not have an as-needed restraint order.

(3) Orders for the use of a restraint shall be time specific.

(4) A resident may not remain in a restraint for more than 2 hours without a change in position and toileting opportunity.

(5) If an order for the use of a restraint is to be continued, the order shall be renewed at least every 7 calendar days by a physician.

(6) The delegating nurse shall provide training to staff in the appropriate use of the restraint ordered by the physician.

F. Bed Rails. Bed rails may be considered a restraint depending upon the reason for the use of bed rails and how the bed rails are used. This determination is based upon the resident and the effect that bed rails would have upon the resident, as documented in the resident’s record.

G. The program shall notify the resident’s family or the resident representative each time a restraint is used.

H. When the resident is under the care of a general hospice care program licensed by the Department and is physically located in an assisted living program licensed by the Department, the general hospice program and the assisted living program shall comply with the requirements of this chapter, COMAR 10.07.21, and federal regulations.