SECTION 415.271. Actions to be Taken Following Release of an Individual from Restraint or Seclusion Initiated in Response to a Behavioral Emergency

(a) Immediately following the release of an individual from restraint or seclusion, a staff member shall:

(1) take action, if appropriate, to facilitate the individual's reentry into the social milieu by providing the individual with transition activities and an opportunity to return to ongoing activities;

(2) observe the individual for at least 15 minutes; and

(3) document in the individual's medical record the steps taken and observations made of the individual's behavior during this transition period.

(b) The facility shall conduct or attempt to conduct debriefings based on the following:

(1) identify what led to the episode and what could have been handled differently;

(2) identify strategies to prevent future restraint or seclusion of the individual, taking into consideration suggestions from the individual and the individual's declaration for mental health treatment, if any;

(3) ascertain whether the individual's physical well-being, psychological comfort, including trauma, and right to privacy were protected or otherwise addressed, as applicable;

(4) counsel the individual(s) in relation to any trauma that may have resulted from the episode; and

(5) when indicated, make appropriate modifications to the individual's treatment plan and/or the treatment plans of other individuals.

(c) Following an episode of restraint or seclusion, the facility shall conduct, or attempt to conduct, the following debriefings.

(1) Staff members who were involved in the episode, other staff members who the facility determine are appropriate, and supervisors shall debrief together as a support mechanism and to identify successes, problems, or necessary modifications as soon after the episode as is practicable in light of facility operations.

(2) When clinically indicated and at a time when the individual has cognitive capacity to understand what could have been done differently to avoid restraint or seclusion, a staff member or members shall conduct a private discussion with the individual, the individual's LAR, if practicable, and family members, if clinically appropriate and available, with the consent of the individual.

(3) If the episode was a restraint, when clinically indicated or upon request of individuals who witnessed the restraint, a staff member or members shall have a private discussion with individuals who witnessed the restraint.

(d) If an individual has been discharged from the facility, does not have the cognitive capacity to understand what he or she could have done differently to avoid restraint or seclusion, where clinically inappropriate, or where not requested pursuant to subsection (c)(3) of this section, the facility does not need to attempt the debriefings described in subsection (c)(2) and (3) of this section. The facility shall document in the individual's medical record the reason for not conducting the debriefing described in subsection (c)(2) of this section.

(e) Any debriefings conducted under subsection (c)(2) or (3) of this section shall be documented in the individual's medical record in a timely manner. Any debriefing conducted pursuant to subsection (c)(1) of this section shall be documented in accordance with facility policy. If debriefing is not conducted, the reasons for not completing the debriefing shall be documented in the individual's medical record.

Source Note: The provisions of this §415.271 adopted to be effective July 22, 2014, 39 TexReg 5581