(a) Initiation.
  (1) Only staff authorized by the facility's policies and procedures and who have met the training requirements of §415.257 of this title (relating to Staff Member Training) and demonstrated competency in the facility's restraint and seclusion training program, may initiate personal restraint in a behavioral emergency.
  (2) Only a physician, registered nurse, or physician assistant in accordance with a physician's delegated authority, may initiate mechanical restraint or seclusion.
(b) Physician's order. Only a physician member of the facility's medical staff may order restraint or seclusion.
  (1) The physician's order for restraint or seclusion shall:
    (A) designate the specific intervention and procedures authorized, including any specific measures for ensuring the individual's safety, health, and well-being;
    (B) specify the date, time of day, and maximum length of time the intervention and procedures may be used, consistent with the time limitations provided for under §415.261 of this title (relating to Time Limitation on an Order for Restraint or Seclusion Initiated in Response to a Behavioral Emergency);
    (C) describe the specific behaviors which constituted the behavioral emergency which resulted in the need for restraint or seclusion;
    (D) be signed and dated, including the time of the order, by the physician or the registered nurse who accepted the prescribing physician's telephone order.
  (2) If restraint or seclusion was ordered by telephone, the ordering physician shall personally sign and date the telephone order, including the time of the order, within 48 hours of the time the order was originally issued.
  (3) If the physician who ordered the intervention is not the treating physician, the physician ordering the intervention shall consult with the treating physician or physician designee as soon as possible. The physician who ordered the intervention shall document the consultation in the individual's medical record.
(c) Face-to-face evaluation. A physician, physician assistant as provided in paragraph (3) of this subsection, or a registered nurse who is trained and has demonstrated competence in assessing medical and psychiatric stability, other than the registered nurse who initiated the use of restraint or seclusion, shall conduct a face-to-face evaluation of the individual within one hour following the initiation of restraint or seclusion to personally verify the need for restraint or seclusion.
  (1) The face-to-face evaluation required by this subsection includes, but is not limited to, an assessment of the:
    (A) individual's immediate situation;
    (B) individual's reaction to the restraint or seclusion;
    (C) individual's medical and behavioral condition; and
    (D) need to continue or terminate the restraint or seclusion.
  (2) The Waco Center for Youth, a facility accredited as a residential treatment program, a physician or a registered nurse who is trained and has demonstrated competence to assess medical and psychiatric stability other than the registered nurse who initiated the use of restraint or seclusion shall conduct the face-to-face evaluation within two hours following the initiation of restraint or seclusion unless the individual is released prior to the expiration of the original order. If the individual is released prior to the expiration of the original order, the physician or registered nurse, shall conduct the face-to-face evaluation within 24 hours.
  (3) A physician may delegate the face-to-face evaluation to a physician assistant who is:
    (A) privileged to practice in the facility or that portion of the facility to which this subchapter applies; and
    (B) under the clinical supervision of a physician appointed by the facility's medical staff and privileged to practice in the facility or that portion of the facility.
  (4) If a physician assistant to whom the physician has delegated the face-to-face evaluation or a registered nurse who has conducted the face-to-face evaluation, in his or her professional judgment determines that the physician should evaluate the individual due to circumstances that are outside the physician assistant's or registered nurse's scope of practice or expertise, the physician assistant or registered nurse shall contact a physician and request that the physician perform a face-to-face evaluation of the individual. The physician assistant or registered nurse shall document the determination in the individual's medical record.
  (5) If the face-to-face evaluation is conducted by a registered nurse or physician assistant, the registered nurse or physician assistant shall consult the treating physician or physician designee who is responsible for the care of the individual as soon as possible after the completion of the one hour face-to-face evaluation and document the consultation in the individual's medical record.

Source Note: The provisions of this §415.260 adopted to be effective July 22, 2014, 39 TexReg 5581