SECTION 415.253. Definitions

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.

(1) Advanced practice registered nurse or APRN--A registered nurse authorized by the Texas Board of Nursing to practice as an advanced practice registered nurse.

(2) Behavioral emergency--A situation involving an individual who is behaving in a violent or self-destructive manner and in which preventive, de-escalative, or verbal techniques have been determined to be ineffective and it is immediately necessary to restrain or seclude the individual to prevent:

(A) imminent probable death or substantial bodily harm to the individual because the individual is attempting to commit suicide or inflict serious bodily harm; or

(B) imminent physical harm to others because of acts the individual commits.

(3) Chemical restraint--The use of any chemical, including pharmaceuticals, through topical application, oral administration, injection, or other means, for purposes of restraining an individual and which is not a standard treatment for the individual's medical or psychiatric condition.

(4) Chief executive officer (CEO)--The highest ranking administrator of a facility or such person's designee.

(5) Clinical timeout--A procedure in which an individual, in response to verbal suggestion from a staff member, voluntarily enters and remains for a period of time in a designated area from which the individual is not prevented from leaving.

(6) Competence--Demonstrated knowledge, skill, and ability.

(7) Continuous face-to-face observation--An in-person line of sight that is maintained in an uninterrupted manner and is free of distraction.

(8) Declaration for mental health treatment--A document making a statement of preferences or instructions for mental health treatment as set forth in Texas Civil Practice and Remedies Code, Chapter 137.

(9) DSHS--The Department of State Health Services.

(10) Emergency medical condition--A non-psychiatric medical condition manifesting itself by acute symptoms, including severe pain, of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in serious impairment to bodily functions, serious dysfunction of any bodily organ or part, or a threat to the health or safety of a pregnant woman or her unborn child.

(11) Emergency medication--A psychoactive medication that is used to treat the signs and symptoms of mental illness in a psychiatric emergency, as that term is defined in Chapter 415, Subchapter A of this title (relating to Prescribing of Psychoactive Medication), when other interventions are ineffective or inappropriate.

(12) Episode--The time period from the initiation of restraint or seclusion until the release of the individual.

(13) Face-to-face--Describes a contact with an individual that occurs in person. Face-to-face does not include a contact made through the use of video or telecommunication conferencing or technologies, including telemedicine.

(14) Facility--An entity to which this subchapter applies as identified in §415.252 of this title (relating to Application).

(15) Individual--Any person receiving mental health services from a facility.

(16) Initiate--The first overt act to restrain or seclude an individual.

(17) Legally authorized representative (LAR)--A person authorized by law to act on behalf of an individual with regard to a matter described in this subchapter, and who may include a parent, guardian, or managing conservator of a minor individual; guardian of the person of an adult individual; or person with activated power of attorney for health care decisions.

(18) Mechanical restraint--Any device, material, or equipment that immobilizes or reduces the ability of the individual to move his or her arms, legs, body, or head freely.

(19) Mental health services--All services concerned with research, prevention, and detection of mental disorders and disabilities, and all services necessary to treat, care for, control, supervise, and rehabilitate persons who have a mental disorder or disability, including persons whose mental disorders or disabilities result from alcoholism or drug addiction.

(20) Non-violent, non-self-destructive behavior--Behavior related to a non-psychiatric medical condition or symptom that indicates the need for an intervention to protect the individual from harm.

(21) Personal restraint--Any manual method by which a person holds or otherwise bodily applies physical pressure that immobilizes or reduces the ability of the individual to move his or her body or a portion of his or her body.

(22) Physician assistant--A person who is licensed under Texas Occupations Code, Chapter 204.

(23) PRN--As needed (pro re nata).

(24) Protective device--A device used to prevent injury or to permit wounds to heal.

(25) Quiet time--A procedure in which an individual, on the individual's own initiative, enters and remains for a period of time in a designated area from which the individual is not prevented from leaving.

(26) Registered nurse--A person who is licensed under Texas Occupations Code, Chapter 301, and who has demonstrated the clinical competencies required by this subchapter.

(27) Restraint--The use of any personal restraint or mechanical restraint that immobilizes or reduces the ability of the individual to move his or her arms, legs, body, or head freely.

(28) Seclusion--The involuntary separation of an individual from other individuals for any period of time and or the placement of the individual alone in an area from which the individual is prevented from leaving.

(29) Seclusion room--A hazard-free room or other area in which direct observation of an individual can be maintained and from which the individual is prevented from leaving.

(30) Serious injury--An injury determined by a physician to require medical treatment by a licensed medical professional (e.g., physician, osteopath, dentist, physician's assistant, or advance practice nurse), or requires medical treatment in an emergency department or licensed hospital.

(31) Staff member--A person directly involved in an individual's care, including professionals who are credentialed and granted privileges by the facility, full-time and part-time employees, and contractors.

(32) Supportive device--A device voluntarily used by an individual to posturally support the individual or to assist the individual who cannot obtain or maintain normal bodily functioning.

(33) Treating physician--The physician assigned by the facility and designated in the individual's medical record as the physician responsible for the coordination and oversight of the implementation of an individual's comprehensive treatment plan and who is:

(A) licensed as a physician by the Texas Medical Board in accordance with Texas Occupations Code, Chapter 155; or

(B) authorized to perform medical acts under an institutional permit at a Texas postgraduate training program approved by the Accreditation Council for Graduate Medical Education, the American Osteopathic Association, or the Texas Medical Board.

(34) Treatment team--A group of staff members, the individual, and LAR (if any) who work together in a coordinated manner for the purpose of providing comprehensive mental health services to an individual.

Source Note: The provisions of this §415.253 adopted to be effective July 22, 2014, 39 TexReg 5581