/ Tennessee Department of Children’s Services
Authorization for the Use of Mechanical Restraints and Procedures for Inoperable Mechanical Restraints
TO: / All / Mountain ViewWilderWoodland Hills / Youth Development Center Employees
FROM: / Mountain ViewWilderWoodland Hills / , Superintendent / Date: / 10/17/16

Authorization for the Use of Mechanical Restraints for Medical/Mental Health Purposes

It is preferred that youth are not restrained for medical or mental health purposes.

Per DCS Policy 19.1, Suicide/Self Harm and Intervention in YDC’s, when a youth is at imminent risk of harm to self or others, or in an emergency situation with suicidal youth staff notifies Crisis Management Services for an assessment to determine psychiatric treatment needs. Per DCS Policy 27.35,Use of Mechanical Restraints, mechanical restraints may be used for these types of situations when no other option exists to protect the safety of the youth and staff. Only the physician can order the use of mechanical restraints for medical purposes.

Nurses document compliance with the monitoring requirements in the youth’s medical file. An Incident Report is completed in accordance with DCS Policy 1.4, Incident Reporting.

Approved and reviewed by:

Add name here, Health Administrator / Date
Add name here, Medical Doctor / Date

Authorization for the Use of Mechanical Restraints

Per DCS Policy 27.35, Use of Mechanical Restraints, superintendents shall designate in writing those staff members authorized to approve the use of mechanical restraints and those authorized to routinely carry mechanical restraints. The Superintendent and Security Manager are the only ones authorized to give approval to use shields. The Superintendent has the authority to restrict staff from being able to use, carry or approve the use of Mechanical Restraints.

The following list of staff is authorized to approve the Use of Mechanical Restraints:

Superintendent

Security Manager (DCSMS)

Shift Supervisor

Enter Approved Children's Services Managers

The following list of staff is authorized to routinely carry Mechanical Restraints:

All Trained Youth Service Workers

Inoperable Mechanical Restraints:

In the event that mechanical restraints are determined to be inoperable when applied to a youth, the supervising staff will immediately contact the on-duty Shift Supervisor.

A set of bolt cutters will be maintained in / for the purpose of

cutting inoperable restraints and may only be used with the approval of the on duty Shift Supervisor. If nursing staff are on-site, they will be present during the actual removal of the inoperable restraints. The Shift Supervisor will be present when nursing staff is not on-site.

The use of bolt cutters for the removal of inoperable restraints will be fully documented in an incident report. The Shift Leader will notify the CSM-Security and Superintendent. The unserviceable restraints along with the incident report will be submitted to the Key and Tool Control Officer, who will provide a copy of the incident report to the CSM-Security for logging.

Name of YDC, Street Address, City, State Telephone Number

Check the “Forms” Webpage for the current version and disregard previous versions. This form may not be altered without prior approval.

Distribution: RDA 2875

CS-1083, 10/16 Page 1