(a) If a facility's policies and procedures permit the use of mechanical restraint, only commercially available or DSHS-approved devices specifically designed for the safe and comfortable restraint of humans shall be used. Any alteration of commercially available devices or independent development of devices must:
  (1) be based on the individual's special physical needs, if any (e.g., obesity or physical impairment);
  (2) take into consideration any potential medical (including psychiatric) contraindications, including any history of physical or sexual abuse;
  (3) be approved by a committee whose membership and functions are specified in the bylaws of medical staff members of the facility; and
  (4) be described fully in writing, with a copy of the description and a photograph forwarded to the DSHS medical director for behavioral health for review. Such altered or independently developed device may not be used by the facility unless and until its use is approved, in writing, by the DSHS medical director for behavioral health.
(b) A staff member shall inspect a device before and after each use to ensure that it is clean, in good repair, and is free from tears or protrusions that may cause injury. Damaged devices shall not be used to restrain an individual and shall be repaired or discarded.
(c) Regardless of their commercial availability, the following types of devices shall not be used to implement a restraint:
  (1) those with metal wrist or ankle cuffs;
  (2) those with rubber bands, rope, cord, or padlocks or key locks as fastening devices;
  (3) long ties (e.g., leashes);
  (4) bed sheets;
  (5) gags;
  (6) spit hoods, or anything that obstructs an individual's airway, including a device that places anything in, on, or over the individual's mouth or nose; and
  (7) strait jackets.
(d) Except as otherwise permitted in this subsection, all forms of restraint, as well as a form of restraint in conjunction with seclusion, are intended to be used independently of one another. The physician shall document the clinical justification in the individual's medical record for the simultaneous use of more than one mechanical restraint device, a mechanical restraint device and personal restraint, a mechanical restraint device and seclusion, or personal restraint and seclusion.
(e) The following are approved mechanical restraint devices.
  (1) Anklets--Padded bands of cloth or leather that are secured around the individual's ankles or legs using hook-and-loop (e.g., Velcro®) or buckle fasteners and attached to a stationary object (e.g., bed or chair frame). The device shall not be secured so tightly as to interfere with circulation, or so loosely as to permit chafing of the skin.
  (2) Arm splints or elbow immobilizers--Strips of any material with padding that extend from below to above the elbow and which are secured around the arm with ties or hook-and-loop (e.g., Velcro®) tabs. If appropriate under the circumstances, they shall be secured so that the individual has full use of the hands. The device shall not be secured so tightly as to interfere with circulation, or so loosely as to permit chafing of the skin.
  (3) Belts--A cloth or leather band that is fastened around the waist and secured to a stationary object (e.g., chair frame) or used for securing the arms to the sides of the body. The device shall not be secured so tightly as to interfere with breathing or circulation.
  (4) Camisole--A sleeveless cloth jacket that covers the arms and upper trunk and is secured behind the individual's back. The device shall not be secured so tightly as to interfere with breathing or circulation or to cause muscle strain. Staff members shall exercise caution when using this device, if at all, because it may impair balance and the individual's ability to break a fall.
  (5) Chair restraint--A padded stabilized chair that supports all body parts and prevents the individual's voluntary egress from the chair without assistance (e.g., tabletop chair, Geri-chair). When wristlets or anklets are used to restrict movement from the chair, the devices must not be secured so tightly as to interfere with breathing or circulation.
  (6) Enclosed bed--A bed with high side rails or another type of side enclosure and, in some cases, an enclosure (e.g., mesh or rails) over the bed that prevents the individual's voluntary egress from the bed without assistance.
  (7) Helmet--A plastic, foam rubber, or leather head covering, such as a sports helmet, that may include an attached face guard but does not include a spit guard that interferes with breathing or obstructs the airway. The device shall be the proper size and the chinstrap shall not be so tight as to interfere with breathing or circulation.
  (8) Mittens--A cloth, plastic, foam rubber, or leather hand covering such as boxing and other types of sport gloves that are secured around the wrist or lower arm with elastic, hook-and-loop (e.g., Velcro®) tabs, ties, paper tape, pull strings, buttons, or snaps. The device shall not be secured so tightly as to interfere with circulation.
  (9) Restraining net--Mesh fabric that is placed over an individual's upper and lower trunk with the head, arms, and lower legs exposed; the net shall be secured over a mattress to a bed frame and shall never be placed over the individual's head. The restraining net shall be loose enough to allow some movement. The device shall not be secured so tightly as to interfere with breathing or circulation.
  (10) Restraint bed--A stretcher of steel frame construction with a fabric cover. The restraint bed shall have an adjustable backrest and a padded mat which shall be used under the individual's head and upper body to prevent injury. Approved wristlets, anklets, and belts shall be used to safely and securely limit the individual's physical activity.
  (11) Restraint board--A padded, rigid board to which an individual is secured face-up, unless that position is clinically contraindicated for that individual, in which case a clinically indicated position will be used and documented. This device shall not be used to restrain an individual in a behavioral emergency except when necessary to promptly transport an individual to another location.
  (12) Restraint chair or gurney--A chair or gurney manufactured for the purpose of transporting or restraining an individual.
  (13) Ties--A length of cloth or leather used to secure approved mechanical restraints (e.g., mittens, wristlets, arm splints, belts, anklets, vests) to a stationary object (e.g., bed or wheelchair frame) or to another approved mechanical restraint. Ties shall not be secured so tightly as to interfere with breathing or circulation.
  (14) Transport jacket--A heavy canvas sleeveless jacket that encases the arms and upper trunk, fastens with hook-and-loop (e.g., Velcro®) tabs and roller buckles, and is held in place with a strap between the legs. The device shall be used only as a temporary measure during transport.
  (15) Vest--A sleeveless cloth jacket that covers the upper trunk and is fastened in the back or front with ties or hook-and-loop tabs (e.g., Velcro®). The vest may be secured to a stationary object (e.g., bed or chair frame). The vest and ties shall not be secured so tightly as to interfere with breathing or circulation.
  (16) Wristlets--Padded cloth or leather bands that are secured around the individual's wrists or arms using hook-and-loop (e.g., Velcro®) or buckle fasteners and attached to a stationary object (e.g., bed frame, chair frame, or waist belt). The device shall not be secured so tightly as to interfere with circulation or so loosely as to permit chafing of the skin.

Source Note: The provisions of this §415.256 adopted to be effective July 22, 2014, 39 TexReg 5581