6.1 YCS - POLICY & PROCEDURE MANUAL
Residential Policies
PHYSICAL CONTROL POLICY
Policy: From time to time, it is necessary to physically control a child in order to help him regain control of his behavior if he is a danger to himself or others. It is the policy of YCS to provide quality care to the children in its charge, and to document same in accordance with regulatory mandates. As such, a well defined, multi-step procedure for the safe physical control and required documentation of same is outlined below.
Important Note: At all times, physical control will be used as a last resort and only in order to protect children who are a danger to themselves or posing a danger to others. Physical control may only be initiated and performed by staff who have been trained in either Crisis Prevention Institute, Inc.’s Nonviolent Crisis Intervention® (CPI) and/or the Handle With Care (HWC) programs and who are currently CPR Certified (CPR Certification is required annually). Only CPI and/or HWC therapeutic holding techniques may be utilized by trained staff.
Procedure:
Admission Procedures:
YCS Physical Control Policy
1. Upon admission to a YCS residential program, the admitting clinician shall present the child/parent/legal guardian with a copy of the YCS Physical Control Policy.
a. This policy shall be explained to the child/parent/legal guardian.
b. This document addresses Parental/Legal Guardian notification about physical controls. Parents/Legal Guardians may choose to be notified as soon as possible to their preference which means within 24 hours after each incident, weekly, or along with Treatment Conference Invitations. If the parent/legal guardian chooses to be notified within 24 hours after the physical control, the Clinician or designee shall make a copy of the signed page 6 of the policy and give a copy to the nursing department. The nursing staff will be responsible for the notification. If they choose to be notified either weekly or along with Treatment Conference Invitations, the child’s Clinician shall be responsible for the notification. The parent/guardian must be notified within 10 hours of the child’s first physical control.
c. The child/parent/legal guardian shall sign the policy.
d. The signed original shall be placed in the Social Service chart.
e. The parent/legal guardian shall receive a copy of the signed policy.
YCS Physical Control Admission Assessment Form
2. Next, the admitting clinician shall present and review the YCS Physical Control Admission Assessment Form with the child/parent/legal guardian.
a. The child/parent/legal guardian shall sign this document.
b. The Clinician will share the contents of this document with child care staff so that they are aware of the child’s triggers and ways in which to help minimize the need for physical control.
c. This document shall be a part of the Treatment Plan and filed in the Clinical Chart.
YCS Admission Medical History & Physical Exam and Physical Control Assessment
3. Before a child may be physically controlled, he must be evaluated by a physician/advanced practice nurse and the YCS Admission Medical History & Physical Exam and Physical Control Assessment Form must be completed and signed by the physician/advanced practice nurse.
a. This form will indicate any documented ailments and precautions/contraindications to physical control and shall be filed in the Medical Chart in the Doctor/APN Section.
b. The Nurse will communicate any such precautions/contraindications to staff via the YCS Medical Alert form. The nurse will also file a copy of the Medical Alert in the Medical Chart in the Nurses Section.
c. Each site shall maintain a Medical Alert Binder that’s kept in the child care supervisor’s office.
d. The child care supervisor/senior child care worker shall be responsible for placing the Medical Alert in the binder and notifying all child care staff about the alert.
e. At the start of each shift, all staff are responsible for checking the Medical Alert Binder for new alerts and/or updates.
Ordering and Receiving Orders for Physical Controls:
YCS Physical Control Order Form
4. At such time during the child’s tenure with a YCS Residential Program, when he is a danger to himself or others, and alternative techniques have not been successful in de-escalating the child’s behavior, physical control may be required.
a. Physical control may only be initiated and performed by staff who have successfully completed the CPI and/or HWC programs and who are currently CPR Certified (CPR Certification is required annually). Only CPI and/or HWC therapeutic holding techniques may be utilized by trained staff.
b. When physical control is required, an Order must be obtained from a physician or advanced practice nurse.
c. Said Order must be obtained either before initiating a physical control, during a physical control or no later than one hour after the initiation of the physical control.
d. Said Order shall be documented on the YCS Physical Control Order Form.
e. The Order may be received by any licensed professional or a non-licensed professional who has been trained to receive Orders for physical control such as a Residential Assistant or Supervisor Residential Assistants. Once they have received YCS Certification to Receive Orders for Physical Control they may receive Orders from a physician or advanced practice nurse for the sole purpose of physical control (all other Orders may only be received by Nursing staff).
Procedure for obtaining Orders and follow up required:
i. When a physical control is initiated Monday through Friday, between the hours of 9am and 5pm, the child’s regular treatment team psychiatrist should be called for the Order for physical control.
ii. At any other time, the “On-Call” Physician/APN as listed on the “monthly physical control on-call schedule” shall be called for the Order for physical control.
iii. Immediately after the physical control has ended, the Residential Assistant Supervisor shall complete the YCS Physical Control Order Form.
iv. If the child’s regular treatment team psychiatrist has Ordered the physical control, and is onsite, then the Supervisor/Residential Assistant shall give the Order form to the Nurse to give to the treatment team Psychiatrist/APN for him/her to sign.
v. If the Order was obtained by phone from the treatment team Psychiatrist/APN, the Order shall by signed as soon as possible, within two weeks of the physical control.
vi. If the order was obtained from the “On-Call” Physician/APN, then the Supervisor/Residential Assistant shall fax the Order form and a copy of the physical control report to the fax number listed at the bottom of the monthly Physical Control Physician/APN “On-Call” Schedule.
vii. The “On-Call” Physician/APN shall sign and fax back the Order form as soon as possible, within two weeks of the physical control.
viii. At this point, the signed form shall be given to the Nurse who will then give it to the treatment team Psychiatrist/APN for review and signature.
ix. When all signatures have been obtained, the Nurse shall file the Order form in the Medical Chart, under the Physician Order Section.
Notes:
Ø No child may be physically controlled for more than one hour per episode.
Ø For physical controls lasting more than 15 minutes, the following must occur:
§ The YCS Physical Control 15 Minute Check form must be completed.
Post Physical Control Reporting and Documentation
YCS Physical Control/Separation Report
5. After a physical control has ended, the YCS Physical Control/Separation Report must be completed.
a. The front side of this form shall be completed by the staff involved in the physical control and/or their supervisor.
b. The back of the form shall be completed as indicated.
i. The Explanation for completing a Physical Control Report indicates how to complete this entire form.
c. These reports shall be aggregated on a monthly basis and reported at local CPI meetings and semiannually at central CPI meetings.
d. After aggregation, these forms shall be filed in a folder with the child’s name, which is kept separate from the child’s chart.
YCS Post Physical Control Nursing Assessment
6. Immediately after a physical control, child care staff shall notify the Nurse (either the on-site Nurse, or the “on-call” Nurse if no Nurse is present on-site).
a. A Nurse must examine the child within one hour of the initiation of the physical control.
b. The Nurse shall complete the YCS Post Physical Control Nursing Assessment and arrange for any care as indicated.
c. This Assessment shall be filed in the Medical Chart.
d. The Nurse is also responsible for promptly within the next business day notifying the child’s regular treatment team Psychiatrist/APN and documenting same on the YCS Physical Control/Separation Report and the YCS Physical Control Order Form.
e. Additionally, if the parent/legal guardian indicated that they wish to be notified of each physical control within 24 hours, the Nurse shall do so and document same on the YCS Physical Control Separation Report.
f. After being completed, The YCS Post Physical Control Nursing Assessment shall be filed in the Medical Chart and attached to the Physical Control Order Form in the Physicians Order Sheet Section.
YCS Post-Physical Control Child Debriefing Form
7. Within 24 hours following the episode of physical control, the YCS Post-Physical Control Child Debriefing Form must be completed.
a. The following people must meet to discuss the episode:
· child(ren) involved in the episode;
· all staff involved in the episode;
· child’s therapist and/or treatment team physician (if available)
b. The RA supervisor on the shift that the physical control occurred shall ensure that this form is completed and that each team member is notified of the incident.
c. If any of the above people are not involved in the debriefing session, document the names of the absent persons and the reasons why they were not present.
d. The form should be signed as indicated.
e. Regardless of whether or not the clinician is available to take part in this debriefing, the clinician must follow-up with the client regarding the physical control, and document this follow-up in a progress note.
f. The form shall be filed by the clinician in the Social Service chart.
YCS Post-Physical Control Staff Debriefing Form
8. Within 24 hours following the episode of physical control, the YCS Post-Physical Control Staff Debriefing Form must be completed.
a. The following people must meet to discuss the episode:
· all staff involved in the episode;
· administrative staff;
· supervisory clinical staff
b. If any of the above people are not involved in the debriefing session, document the names of the absent persons and the reasons why they were not present.
c. The administrative staff should complete the form.
d. The form should be signed as indicated.
e. A copy of the signed form shall be stapled to, and filed along with the YCS Physical Control Separation Report.
f. If the child was injured during the physical control, an Unusual Incident Report (UIR) shall be completed. If the child is injured, the guardian must be notified within 24 hours of the occurrence.
Definitions:
· JC 2008 PC 11-12
“Restraint is any method of restricting a child’s freedom of movement, including seclusion, physical activity, or normal access to his or her body that is not a usual and customary part of the medical diagnostic or treatment procedure to which the client or his or her representative has consented; is not indicated to treat the resident’s medical condition or symptoms; or does not improve the client’s independent functioning”
“The standards for restraint…do not apply when a staff member physically redirects…a child without the child’s permission, for 30 minutes or less.”
· CMS (formerly HCFA) Interim Final Rule & NJ DHS, DMAHS Newsletter, Volume 12, No. 72
“Personal restraint means the application of physical force without the use of any device, for the purpose of restricting the free movement of a resident’s body. Personal restraint does not include briefly holding, without undue force, a resident in order to calm or comfort the resident or holding a resident’s hand or arm in order to safely escort a resident from one area to another.”
Legal/Regulatory References:
· US Department of Health and Human Services – Centers for Medicare and Medicaid Services (CMS) – 42 CFR Parts 441 and 483 – Medicaid Program; Use of Restraint and Seclusion in Psychiatric Residential Treatment Facilities Providing Inpatient Psychiatric Services to Individuals Under Age 21 (May 22, 2001 – Interim final rule).
· NJ Department of Human Services, Division of Medical Assistance & Health Services Newsletters:
- July 2001 – Volume 11, No. 64 (Restraint and Seclusion Procedures for Medicaid, NJ FamilyCare and Children’s System of Care Initiative Providers);
- November 2001 – Volume 11, No. 82 (Clarification of Restraint and Seclusion Requirements for a Psychiatric Residential Treatment Center (PRTC) Providing Services to Beneficiaries Under 21 Years of Age);
- July 2002 – Volume 12 (Additional Clarification Regarding the use of Restraints and Seclusion in JCAHO –Accredited Residential Treatment Centers);
- September 2002 – Volume 12, No. 72. (Additional Clarification Regarding the use of Restraints and Seclusion in JCAHO-Accredited Residential Treatment Centers).
· NJ DYFS Manual of Requirements of Residential Care Facilities (NJAC 10:127-6.13) – Restrictive Behavior Management Practices
Voluntary Standards:
· Crisis Prevention Institute’s Non-violent Crisis Intervention Training and Certification (CPI)
· Handle With Care Training and Certification (HWC)
(Created 3/03; revised 5/03; revised 6/03; revised 7/06; revised 12/06, 4/09, 6/09, 6/10)
Revised 6/16/10 P:\Research\PIA\CRM\6.1 p.5