Colorado Regulation Rewriting Existing Chapter of Standards for Hospitals and Health Facilities 6 CCR 1011-1 Chapter 2

On January 14, 2020, the state of Colorado put into effect revisions to the existing regulations in the Chapter of Standards for Hospitals and Health Facilities under section 6 CRR 1011-1 Chapter 2 (PDF). Revisions pertain to the addition of restrictions on the use of restraint and seclusion as applied in these facilities.

• "Physical restraint" means the use of bodily, physical force to involuntarily limit an individual's freedom of movement; except that "physical restraint" does not include the holding of a child by one adult for the purposes of calming or comforting the child.

• "Restraint" means any method or device used to involuntarily limit freedom of movement, including but not limited to bodily physical force, mechanical devices, or chemicals. "Restraint" includes a chemical restraint, a mechanical restraint, a physical restraint, and/or seclusion.

• A facility may only use restraint or seclusion:
  • In cases of emergency, as defined at section 26-20-102(3), C.R.S., to be a serious, probable, imminent threat of bodily harm to self or others where there is the present ability to effect such bodily harm; and
    • After the failure of less restrictive alternatives; or
    • After a determination that such alternatives would be inappropriate or ineffective under the circumstances.
  • A facility or agency that uses restraint or seclusion pursuant to the provisions of (A), above, shall use such restraint or seclusion:
    • Only for the purpose of preventing the continuation or renewal of an emergency;
    • Only for the period of time necessary to accomplish its purpose; and
    • In the case of physical restraint, using no more force than is necessary to limit the client's freedom of movement.

• Restraint and seclusion must never be used:
  • As a punishment or disciplinary sanction,
  • As a means of coercion by staff,
  • As part of an involuntary treatment plan or behavior modification plan,
  • For the convenience of staff,
  • For the purpose of retaliation by staff, or
  • For the purpose of protection, unless:
    • The restraint or seclusion is ordered by the court, or
    • In an emergency, as provided for in 8.3.1(A), above.
• A facility or agency that uses restraint shall ensure that:
  • (B) No physical or mechanical restraint of a client shall place excess pressure on the chest or back of that client or inhibit or impede the client's ability to breathe;
  • During physical restraint of a client, an agent or employee of the facility or agency shall check to ensure that the breathing of the client in such physical restraint is not compromised;

• A client in physical restraint shall be released from such restraint within fifteen (15) minutes after the initiation of physical restraint, except when precluded for safety reasons.

• 8.5.1 All facilities and agencies shall ensure that all staff involved in utilizing restraint or seclusion are trained in the appropriate use of restraint and seclusion.
  • All facilities and agencies shall ensure that staff are trained to explain, where possible, the use of restraint or seclusion to the client who is to be restrained or secluded and to the client's designated representative, if appropriate.

• 8.6.1 Each facility shall ensure that an appropriate notation of the use of restraint or seclusion is documented in the record of the client who was restrained or secluded. Each facility shall document the following in the client record:
  • Type of restraint and length of time in the restraint or seclusion;
  • Identification of staff involved in the initiation and application of the restraint or seclusion;
  • Care provided while in the restraint or seclusion, including monitoring conducted and relief periods granted; and
  • The effect of the restraint or seclusion on the client.

• Each facility or agency that Utilizes restraint or seclusion under this Part 8 shall ensure that a review process is established for the appropriate use of the restraint or seclusion.

• 8.8.1 A facility or agency that uses restraint or seclusion shall develop and implement policies and procedures consistent with the requirements of this Part 8.
  • A facility's or agency's policies and procedures regarding the use of restraint and seclusion may be more stringent than this Part 8, but shall not be less stringent.

CPI offers training and resources to help healthcare facilities meet legislative mandates like the policy requirements set forth in the Colorado regulations. Nonviolent Crisis Intervention^® training equips staff with techniques for both the prevention of and the safe use of restraint. Our train-the-trainer program helps staff identify underlying causes of client behaviors, and how staff and client behaviors affect each other. The program also emphasizes:

• Evaluating risk of harm and signs of distress.
• Documenting incidents.
• Safer, less restrictive holding skills to be used only as a last resort.
• Behavioral supports.
• Implementing evidence-based practices.

How Our Free CPI Alignment Can Give You Peace of Mind—and Help You Comply
For 40 years, CPI has supported healthcare organizations that strive to provide the safest environment for clients, staff, and visitors. We help healthcare facilities ensure that they comply with new and existing legislation by publishing Alignment documents that help administrators and their legal advisors compare an inventory of what specific legislation requires of them and how CPI training can ensure they comply.  
 
Our Alignment for the Colorado Chapter of Standards for Hospitals and Health Facilities section 6 CRR1011- 1 Chapter 2 shows line by line the ways in which CPI Nonviolent Crisis Intervention^® Training complies with the new regulation requirements. Our Alignment also assists you in identifying areas that may require a review and/or revision in your healthcare facility’s policies and procedures.