This regulation governs the use of drugs as chemical restraints in DC Department of Behavioral Health (DBH) licensed mental health facilities. Only a licensed physician may order a chemical restraint, and only in emergencies where the consumer poses imminent risk of serious injury and less restrictive alternatives have failed. The ordering physician must conduct a face-to-face assessment within one hour, and trained staff must monitor the consumer every 15 minutes for the first two hours following administration. Detailed documentation requirements apply to both the order and the clinical record.
View official source514 DRUG(S) USED AS A RESTRAINT 514.1 Only a physician licensed to practice medicine in the District may order a drug(s) to be used as a restraint. 514.2 A drug(s) used as a restraint is permitted only in an emergency when the consumer presents an imminent risk of serious injury to self or others and when alternative techniques are determined to be ineffective to prevent serious injury to the consumer or others. 514.3 The use of drugs to control extreme behavior shall not be administered with the intention of immobilizing the consumer's movements or rendering unconscious. 514.4 The physician ordering a drug(s) to be used as a restraint shall conduct a face-to-face assessment of the consumer within one hour of administration of the medication. 514.5 Each verbal or written order for a drug(s) to be used as a restraint shall state: (a) The name of the physician giving the order; (b) The date and time the written order was given; (c) The specific medication and dosage to be administered; (d) The target symptom or behavior for which the drug is ordered; (e) Any special instructions needed due to the consumer's medical condition, physical disability or history of abuse; and (f) If required, the need for monitoring of specific medical conditions or more frequent monitoring of vital signs. 514.6 For each order, the physician, physician assistant or RN shall also document in the consumer's clinical record, a note separate from the order, which shall include: (a) Any less restrictive techniques, such as behavioral interventions or non-physical interventions used, attempted, or considered prior to ordering the drug; (b) Whether there are any pre-existing medical conditions or any physical disabilities that would place the consumer at potentially greater risk due to the use of the drug; and (c) The basis, including a description of the consumer's behavior and the circumstances leading to the use of the drug. 514.7 A trained competent staff person shall regularly assess the consumer for the first two hours after the drug is administered. This assessment shall be documented and include: (a) Assessments for signs of injury or medical distress shall be done every fifteen (15) minutes; and (b) Elicitation of vital signs upon administering the drug with checks every fifteen (15) minutes. If unable to elicit vital signs at any time, the staff shall document efforts to obtain vital signs and the reasons it could not be done. SOURCE: Emergency and Proposed Rulemaking published at 51 DCR 8691 (September 3, 2004)[EXPIRED]; as amended by Emergency and Proposed Rulemaking published at 51 DCR 11863 (December 31, 2004)[EXPIRED]; as amended by Emergency and Proposed Rulemaking published at 52 DCR 5957 (June 24, 2005)[EXPIRED]; as amended by Final Rulemaking published at 52 DCR 7229 (August 5, 2005). District of Columbia Municipal Regulations Mental Health 22-A DCMR § 514