(a) Observation.
  (1) A staff member of the same gender as the individual shall maintain continuous face-to-face observation of an individual in mechanical restraint, unless the individual's history or other factors indicate this would be contraindicated (e.g., sexual or physical abuse perpetrated by someone of the same gender, in which case a staff member of the opposite gender may be used).
  (2) A staff member who is not physically applying personal restraint shall maintain continuous face-to-face observation of an individual in personal restraint.
  (3) A staff member shall maintain continuous face-to-face observation of an individual in seclusion for at least one hour. After one hour, the staff member may monitor the individual continuously using simultaneous video and audio equipment in close proximity to the individual.
(b) Monitoring. A staff member shall ensure adequate respiration and circulation of the individual in restraint at all times.
  (1) Respiratory status, circulation, and skin integrity must be monitored continuously and documented every 15 minutes (or more often if deemed necessary by the ordering physician). Cardiac status must be monitored and documented hourly (or more often if deemed necessary by the ordering physician).
  (2) An assigned staff member must perform range of motion exercises for each extremity, one extremity at a time, for at least five minutes no less frequently than every 60 minutes that an individual is in mechanical restraint.
(c) Care. A staff member must provide for the hygiene, hydration, nutrition, elimination needs, and safety of an individual in restraint or seclusion. The individual in restraint or seclusion shall be provided:
  (1) bathroom privileges at least once every two hours (or more frequently, if requested and not contraindicated, or otherwise required by the individual's circumstances and physical or medical needs);
  (2) an opportunity to drink water or other appropriate liquids every two hours (or more frequently, if requested and not contraindicated, or otherwise required by the individual's circumstances and physical or medical needs);
  (3) an opportunity to bathe at least once daily (or more frequently, if clinically indicated or in the presence of incontinence);
  (4) medications and medical equipment as ordered;
  (5) regularly scheduled meals and snacks served on dishes that are appropriate for safety; and
  (6) an environment that is free of safety hazards, adequately ventilated during warm weather, adequately heated during cold weather, and appropriately lighted.

Source Note: The provisions of this §415.266 adopted to be effective July 22, 2014, 39 TexReg 5581