SECTION 351.46. Restraint Chair

(a) Requirements. In addition to the requirements found in §§351.41, 351.42 and 351.43 of this chapter, the use of the restraint chair shall be governed by the following criteria:

(1) only a professionally manufactured restraint chair approved by the juvenile board may be used in a juvenile facility;

(2) the restraint chair may only be used to prevent self-injury, injury to others, or when a resident displays extremely aggressive or disruptive behavior and other approved restraint techniques are inappropriate or ineffective to control the resident's behavior; and

(3) only a juvenile probation or detention officer who has been trained in the proper use of the restraint chair shall:

(A) be authorized to place a resident in the restraint chair; and

(B) provide supervision of a resident placed in the restraint chair;

(4) circulation checks shall be conducted by a juvenile probation or detention officer every 10 minutes;

(5) length of confinement

(A) a resident shall be released from the restraint chair as soon as the resident is no longer a threat to self or others and the resident can be reasonably controlled by staff;

(B) a resident shall be considered for removal from the restraint chair every ten minutes;

(C) the maximum confinement time in the restraint chair is one hour unless authorized by the facility administrator or designee after examination of the resident's condition by one of the following licensed medical professionals:

(i) emergency medical services (EMS/fire rescue);

(ii) paramedic;

(iii) registered nurse (RN);

(iv) physician (MD);

(v) licensed vocational nurse (LVN);

(vi) physician assistant (PA); or

(vii) emergency medical technician (EMT);

(D) five hours is the maximum total time a resident may be restrained in a restraint chair within a twenty-four hour period;

(6) each use of the restraint chair shall be authorized by the facility administrator or designee;

(7) when occupied, the restraint chair shall be placed in an area with minimum visibility by other residents in the facility; and

(8) there shall be provisions for the inspection and maintenance of the restraint chair.

(b) Prohibitions.

(1) restraint chairs that have been altered, modified or customized in any way from their originally manufactured state and intended use; and

(2) the restraint chair shall not be used to confine any resident for the sole reason as having been designated as being at high risk of suicidal behavior.

(c) Supervision of Resident in Restraint Chair.

(1) level of supervision.

(A) a resident placed in the restraint chair shall be under constant visual supervision until the resident is removed from the chair;

(B) the officer responsible for providing the constant visual supervision of a resident in the restraint chair may have limited concurrent duties only if those duties do not impede the constant visual supervision requirement; and

(C) a resident classified as high risk of suicidal behavior under §351.13(d) of this chapter who is placed in a restraint chair shall be supervised in accordance with §351.13(d)(2)(B) of this chapter;

(2) the officer responsible for providing the constant visual supervision of a resident in the restraint chair shall have physical possession of the key or other mechanism for unlocking or releasing the resident from the restraint chair;

(3) primary control room staff shall not be authorized to provide the constant visual supervision of a resident placed in the restraint chair; and

(4) audio and/or video monitoring cannot substitute for the constant visual supervision;

(d) Required Training. Any juvenile probation or juvenile detention officer authorized to place a resident into a restraint chair shall be trained annually in the proper use of the restraint chair. Training topics shall include but not be limited to:

(1) circumstances that are appropriate for use of the restraint chair;

(2) proper use of the restraint chair, including how to get a resident in and out of the device safely;

(3) supervision procedures for a resident placed in the chair;

(4) monitoring the vital signs and critical circulation points of a resident placed in the restraint chair;

(5) emergency procedures for the removal of a resident from the restraint chair; and

(6) documentation required for use of the restraint chair.

(e) Documentation of Chair Restraints. In addition to any documentation required under §351.43 of this chapter a ten-minute observation log shall be maintained that documents:

(1) justification for the resident's continued restraint in or removal from the restraint chair;

(2) the results of the circulation checks conducted under subsection (a)(4) of this section; and

(3) any medical checks conducted under subsection (a)(5)(C) of this section.

(f) Review of Use of Restraint Chair.

(1) The facility administrator and the juvenile board shall review the use of the restraint chair annually.

(2) The review shall consider and evaluate:

(A) the frequency of use;

(B) the outcomes of the chair's use; and

(C) any needed modifications to policy and procedure concerning the chair.

Source Note: The provisions of this §351.46 adopted to be effective September 1, 2003, 28 TexReg 2953