(1) Prior to the use of a restraint or safety device, the following items must be included in the resident's record:
(a) a consent form signed by the resident or authorized representative that includes documentation that:
(i) the resident or the resident's authorized representative was given a written explanation of the alternatives and any known risks associated with the use of the restraint or safety device;
(ii) cites any pre-existing condition that may place a patient at risk of injury; and
(b) written authorization from the resident's primary physician that specifies the medical symptom that the restraint or safety device is intended to address and the type of circumstances and duration under which the restraint or safety device is to be used.
(2) When a restraint or safety device is used, the following items must be documented in the resident's record:
(a) frequency of monitoring in accordance with documented facility policy;
(b) assessment and provision of treatment if necessary for skin care, circulation and range of motion; and
(c) any unusual occurrences or problems.
(3) During a quarterly re-evaluation, a facility must consider:
(a) using the least restrictive restraint or safety device to restore the resident to a maximum level of functioning;
(b) causes for the medical symptoms that led to the use of the restraint or safety device; and
(c) alternative safety measures if a restraint or safety device is removed. Before removing a restraint or safety device, the resident or the authorized representative and the attending physician must be consulted.