Section 13.8. Seclusion

(a) Definition.

(1) Seclusion.

(i) The placement of a patient/resident in a locked room may be used as a therapeutic technique only.

(ii) The patient’s/resident’s request to spend time in a private unlocked room is not to be considered seclusion and shall be granted if feasible and not therapeutically contra indicated. Quarantine or other preventive health measures are not considered seclusion.

(iii) In mental health facilities children under the age of 14 requiring seclusion shall be continuously monitored within or just outside the seclusion area by mental health personnel, and the room shall not be locked or otherwise secured. Soft inanimate objects shall be made available to the patient to permit the venting of aggression.

(iv) Seclusion shall be used only under the following conditions:

(A) When necessary to protect the patient/resident or others from physical injury.

(B) To decrease the level of stimulation when a patient/resident is in a state of hyperactivity.

(C) When less restrictive measures and techniques have proven ineffective.

(D) Seclusion as defined in this paragraph may not be employed in State center for the retarded.

(2) Exclusion. Within mental health/mental retardation facilities the removing of the patient/resident from his immediate environment and restricting him to another area. Exclusion shall only be employed when it is clearly documented that another less restrictive method has been unsuccessful in controlling the unacceptable behavior. Exclusion shall be limited and documented as a therapeutic technique in the resident’s individual treatment plan. In mental health facilities children under the age of 14 requiring seclusion or exclusion shall be continuously monitored within or just outside the exclusion area by mental health personnel, and the room may not be locked or otherwise secured. Soft inanimate objects shall be made available to the patient to permit the venting of aggression.

(b) Procedures.

(1) In mental health facilities if a patient/resident in voluntary treatment requires seclusion, will not consent to such and requests to be discharged, this request shall be granted unless the procedures and standards of section 302 of the Mental Health Procedures Act (50 P. S. § 7302) regarding emergency involuntary treatment and § 5100.76 (relating to notice of withdrawal) are followed. Similarly, the procedures of section 405 of the Mental Health and Mental Retardation Act of 1966 (50 P. S. § 4405) shall be followed for mentally retarded persons who have been voluntarily admitted, require seclusion, and request to be discharged.

(2) In the case of mental health facilities, authority for seclusion of a patient/resident rests with the Director or his designee. In mental retardation facilities, authority for exclusion rests with the qualified mental retardation professional. In the case of Youth Development Centers, Youth Forestry Camps and all other Departmental institutions authority for seclusion rests with the Superintendent/Assistant Superintendent. Normally, written orders shall precede the placement of a patient/resident in seclusion or exclusion. In emergencies, telephone orders may be accepted, but an order shall be properly countersigned within the time specified by the institution. In no case, however, shall this period exceed 24 hours.

(3) An order for seclusion or exclusion is good for only 24 hours. The time the order is received shall be recorded with the order on the order sheet.

(4) In mental health/mental retardation facilities, telephone orders are not acceptable for continued seclusion or exclusion. The patient/resident shall be seen by a physician within 24 hours, and the order shall be rewritten and supported by a progress note. In Youth Development Centers and Youth Forestry Camps, the resident/patient must be seen by the Superintendent/Assistant Superintendent who will assess the resident’s/patient’s needs and seek professional consultation if indicated.

(5) In the absence of a written or telephone order, a patient/resident may be placed in seclusion or exclusion as a protective measure for no more than 1 hour when the action is immediately necessary.

(6) If a patient/resident is placed in seclusion or exclusion as an emergency procedure, the unit program supervisor or appropriate designated program specialist of the area shall be notified immediately.

(7) In mental health/mental retardation facilities, if the nursing supervisor/designated program specialist, after visiting the patient/resident, deems seclusion or exclusion necessary, the attending physician or his delegate shall be notified immediately. In Youth Development Center or Youth Forestry Camp facilities, if the designated program specialist, after visiting the patient/resident, deems seclusion necessary, the Superintendent/Assistant Superintendent shall be notified immediately.

(8) In facilities, the nursing supervisor or designated program specialist shall document his observations fully on an appropriate progress report.

(9) The following procedure is to be followed when a patient/resident is in seclusion:

(i) Potentially dangerous articles will be removed from the patient/resident. This includes articles of clothing if there are reasonable grounds to believe such clothing constitutes a substantial threat to the health or safety of the patient/resident or others.

(ii) The patient/resident will be checked at no less than 15-minute intervals by personnel.

(iii) The physical needs of the patient/resident will be given prompt response.

(iv) Concise and informative written reports concerning the status of the patient/resident will be prepared and retained in the record of the patient/resident in seclusion or exclusion. Daily written reports concerning patient/residents in seclusion or exclusion shall be prepared and sent to appropriate designated staff of the facility. These reports shall include information as follows:

(A) Identifying data concerning name, age, location in building and record number of patient/resident.

(B) Reason for seclusion or exclusion.

(C) Period of time in seclusion or exclusion.

(D) Brief statement regarding status of patient/resident.

(E) Record of time given for attention to personal needs.