(a) The following definitions apply to this section:
  (1) Critical incident means:
    (A) a medication error;
    (B) a serious physical injury;
    (C) a behavior intervention plan that authorizes restraint;
    (D) an emergency personal restraint;
    (E) an emergency mechanical restraint; or
    (F) an emergency psychoactive medication restraint.
  (2) Emergency mechanical restraint means the use of a mechanical restraint on an individual not in accordance with a written behavior intervention plan approved by the individual's IDT.
  (3) Emergency personal restraint means the use of a personal restraint on an individual not in accordance with a written behavior intervention plan approved by the individual's IDT.
  (4) Emergency psychoactive restraint means the use of a psychoactive medication restraint on an individual not in accordance a written behavior intervention plan approved by the individual's IDT.
  (5) A behavior intervention plan that authorizes restraint means a behavior intervention plan approved by the individual's IDT that authorizes personal restraint, mechanical restraint, or psychoactive medication restraint.
  (6) Mechanical restraint means the use of a device that restricts the free movement of part or all of an individual's body, including the use of an anklet, a wristlet, a camisole, a helmet with fasteners, a mitt with fasteners, a vest, a waist strap, a head strap, or a restraining sheet, but does not include the use of a device that provides support for functional body position or proper balance, such as a wheelchair belt, or that is used for medical treatment, such as a helmet to prevent injury during a seizure.
  (7) Medication error means a difference between what is prescribed to an individual who self-administers medication under the supervision of the program provider or who has medication administered by the program provider and what the individual actually takes, but does not include an individual's refusal to take medication. The following are examples of medication errors:
    (A) an individual takes medication that is not prescribed for the individual, including medication that has been discontinued for the individual or that was improperly labeled;
    (B) an individual takes an amount of medication different from the amount prescribed or the route prescribed for the individual;
    (C) an individual does not take a prescribed dose of medication within one hour before or one hour after the prescribed time; and
    (D) an individual does not take a medication as prescribed in relation to a meal.
  (8) Personal restraint means the application of pressure, except physical guidance or prompting of brief duration that restricts the free movement of part or all of an individual's body.
  (9) Psychoactive medication restraint means the use of a chemical, including a pharmaceutical, to control an individual's activity, if the chemical is not a standard treatment for the individual's medical or psychiatric condition.
  (10) Serious physical injury is an injury determined serious by a physician, physician assistant, advance practice nurse, or a registered nurse, regardless of the cause or setting in which the injury occurred. A serious physical injury may include a fracture, a dislocation of any joint, an internal injury, a contusion larger than two and half inches in diameter, a concussion, a second or third degree burn, a laceration requiring sutures.
(b) A program provider must report to DADS the following information related to the critical incidents that occur in a calendar month:
  (1) the number of medication errors;
  (2) the number of individuals who have behavior intervention plans that authorize restraint;
  (3) the number of times emergency personal restraint was used;
  (4) the number of times emergency mechanical restraint was used;
  (5) the number of times emergency psychoactive medication restraint was used;
  (6) the number of times a serious physical injury was sustained;
  (7) the number of times a serious physical injury was sustained due to personal restraint;
  (8) the number of times a serious physical injury was sustained due to mechanical restraint;
  (9) the number of times a serious physical injury was sustained due to psychoactive medication restraint;
  (10) the number of individuals who required restraint;
  (11) the number of individuals who required emergency personal restraint;
  (12) the number of individuals who required emergency mechanical restraint; and
  (13) the number of individuals who required emergency psychoactive medication restraint.
(c) The program provider must make a report described in subsection (b) of this section within 30 days after the last day of the month in which the critical incidents occur. A program provider must make a separate report for each facility.
(d) A program provider must evaluate its use of restraint at least annually. The evaluation must, at a minimum, compare aggregate data provided by DADS at www.dads.state.tx.us for similarly sized facilities.
(e) Based on its evaluation, the program provider must develop and implement a plan to reduce the use of restraints.

Source Note: The provisions of this §261.229 adopted to be effective November 30, 2011, 36 TexReg 8048; transferred effective October 1, 2020, as published in the Texas Register August 28, 2020, 45 TexReg 6127