N.M. Admin. Code § 8.314.5.8

Current through Register Vol. 35, No. 23, December 10, 2024

Section 8.314.5.8 - SAFEGUARDS CONCERNING RESTRAINTS, RESTRICTIONS AND SECLUSION

A. Seclusion and isolation is prohibited during waiver services.

B. Use of restraints or restrictions is only permitted during the course of delivery of waiver services under strict limitations and oversight.

(1) Certain specific interventions are considered ethically unacceptable for application and, as such, are unequivocally prohibited. Interventions that are prohibited include but are not limited to:

(a) contingent electrical aversion procedures;

(b) seclusion and isolation;

(c) use of time out (for an adult);

(d) use of mechanical or chemical restraints;

(e) use of manual application of any physical restraint, except in emergent situations involving imminent risk of harm to self or others (personal restraints);

(f) overcorrection;

(g) forced physical guidance;

(h) forced exercise;

(i) withholding food, water, or sleep;

(j) public or private humiliation including overreliance on prescribed protective gear or recommended assistive technology that is applied for programmatic convenience, calls undue attention to someone, and is therefore humiliating to the person supported; or

(k) application of water mist, noxious taste, smell, or skin agents.

(l) privacy violations such as body checks and electronic surveillance, remote monitoring in private areas such as bathrooms or bedrooms; or

(m) restricting a person from exiting their home using locks on doors and windows.

(2) Use of restrictive interventions must be documented in the individual's positive behavior support plan or behavioral crisis intervention plan or risk management plan and must be reviewed by the human rights committee prior to implementation.

(3) Chemical restraint is defined as the administration of medication at a dose or frequency to intentionally and exclusively preclude behavior without identifying an underlying anxiety, fear or severe emotional distress or other symptoms of psychiatric/emotional disturbance to be eased, managed or treated. The administration may be regularly scheduled or on a pro re nata (PRN), or "as needed" basis. The use of chemical restraints is prohibited.

(4) The administration of PRN psychotropic medication is allowed when prescribed in advance by the prescribing professional. A PRN psychotropic medication plan is a collaborative document that outlines the behavioral indications for using the medication. A human rights committee must approve use of PRN psychotropic medication prior to its implementation and the procedures that direct support personnel (DSP) must use to gain approval for its implementation.

(5) Mechanical restraints are defined as the use of a physical device to restrict the individual's capacity for desired or intended movement including movement or normal function of a portion of their body. The use of mechanical restraints is prohibited.

(6) Use of any emergency physical restraints must be written into a behavioral crisis intervention plan only and approved by a human rights committee prior to its use. Personal restraints (i.e. emergency physical restraints) are used as a last resort, only when other less intrusive alternatives have failed and under limited circumstances that include protecting an individual or others from imminent, serious physical harm, or to prevent or minimize any physical or emotional harm to the individual. Staff must be trained in both nonphysical and physical interventions.

(7) Any individual for whom the use of emergency physical restraints or PRN psychotropic medications is allowed is required to have a positive behavioral supports assessment, positive behavior support plan, and a behavioral crisis intervention plan or PRN psychotropic medication plan completed by a behavior support consultant in conjunction with the individual's agency nurse and interdisciplinary team.

(8) Ethical, medical or behavioral concerns, use of live or recorded video monitoring/observational systems, and resolution of plans contested on the individual team or provider agency level in local human rights committees are heard and resolved in a statewide and state coordinated human rights committee.

N.M. Admin. Code § 8.314.5.8

8.314.5.8 NMAC - Rp, 8.314.5.8 NMAC, 11-1-12, Adopted by New Mexico Register, Volume XXVII, Issue 04, February 29, 2016, eff. 3/1/2016, Reserved by New Mexico Register, Volume XXIX, Issue 22, November 27, 2018, eff. 12/1/2018, Amended by New Mexico Register, Volume XXXIII, Issue 06, March 22, 2022, eff. 4/1/2022, Amended by New Mexico Register, Volume XXXV, Issue 05, March 12, 2024, eff. 4/1/2024