(a) Non-ambulatory mechanical restraints shall be used only in response to a resident's overt self-injurious behavior and only when other less restrictive interventions or other forms of physical restraint have been deemed to be inappropriate or ineffective.
(b) The initial use of non-ambulatory mechanical restraints shall receive incident-specific authorization from the facility administrator or designee. Standing orders authorizing non-ambulatory mechanical restraints are prohibited.
(c) Non-ambulatory mechanical restraints shall be conducted in an area or room that is not visible to other residents but in a location that is readily accessible to health care professionals or specially trained staff with supervisory responsibilities specific to the oversight of the non-ambulatory mechanical restraints.
(d) A room or cell with fixed or static non-ambulatory mechanical restraint fixtures or mechanisms (e.g., anchoring points or devices) shall be used to house a resident who is not being restrained in a non-ambulatory mechanical restraint only if the resident is being provided constant supervision.
(e) Non-ambulatory mechanical restraints shall be restricted to professionally manufactured, standards-compliant restraint beds, restraint chairs, and soft restraint devices.
(f) A written recommendation from a health care professional or a mental health provider is required for a non-ambulatory mechanical restraint to continue longer than one hour.
(g) Non-ambulatory mechanical restraints lasting two hours in duration shall be considered a behavioral health crisis and shall result in an immediate referral to a mental health provider or a mental health facility for assessment and possible treatment.
(h) Under no circumstances shall a non-ambulatory mechanical restraint exceed three hours in duration within a 24-hour period. The collective time a resident spends in multiple non-ambulatory mechanical restraints occurring within a 24-hour period shall not exceed three hours.
(i) Residents in a non-ambulatory mechanical restraint shall be provided:
  (1) constant visual supervision by a juvenile supervision officer or juvenile probation officer;
  (2) an opportunity for expanded physical motion for not less than five minutes at every 30-minute interval;
  (3) an opportunity to drink water every hour;
  (4) regularly prescribed medications, unless otherwise ordered by a physician; and
  (5) an opportunity to eliminate bodily waste at least every hour.
(j) The constant visual supervision required in subsection (i)(1) of this section may be from behind an architectural barrier, such as a window, as long as the constant visual supervision is not interrupted or impeded.
(k) Requirements in subsection (i) of this section shall be fully documented and retained in the facility record or resident file. The juvenile supervision officer or juvenile probation officer shall document any instance in which the resident's aggressive behavior prevents staff from providing any of the items listed in subsection (i) of this section.
(l) The following documentation shall be retained in the facility record or resident file:
  (1) an assessment of the resident's circulation, positioning, and breathing conducted at least every ten minutes by a specially trained juvenile supervision officer or a health care professional; and
  (2) documented checks, performed by a health care professional or specially trained staff, of the physical condition of the resident and the placement of the mechanical restraint devices within the first 30 minutes of the restraint and every hour thereafter.
(m) The officer responsible for providing the constant visual supervision of a resident in a non-ambulatory mechanical restraint shall have physical possession of the key or other mechanism for releasing the resident from the restraint.
(n) Any juvenile probation officer or juvenile supervision officer authorized to place a resident in a non-ambulatory mechanical restraint shall be trained in topics that include:
  (1) monitoring the vital signs and critical circulation points of a resident placed in the non-ambulatory mechanical restraint; and
  (2) emergency procedures for the removal of a resident from the non-ambulatory mechanical restraint.

Source Note: The provisions of this §343.812 adopted to be effective January 1, 2010, 34 TexReg 7095; amended to be effective September 1, 2013, 38 TexReg 4387; amended to be effective January 1, 2015, 39 TexReg 9243