CMS SOM App. J, Tag W282

Guidance §483.450(b)(1)(iv)(D)

"Application of painful or noxious stimuli" is defined as any procedure by which staff apply,

contingent upon the exhibition of maladaptive behavior, startling, unpleasant, or painful stimuli,

or stimuli that have a potentially noxious effect.

While the regulation permits the use of painful or noxious stimuli these techniques are the last

resort and can only be utilized for behaviors that are causing significant harm and have not

responded to competently administered interventions of less intrusive nature.

Facility policies must state that:

• The use of noxious stimuli is only permitted when the client exhibits behaviors so severe

that they present a potential risk for significant or even life-threatening circumstances;

• the IDT and facility must weigh the potential risk of the behavior against the risk

involved in the use of the painful or noxious techniques to manage behavior;

• that safeguards and strict oversight must be in place for consideration to use techniques

that may be painful or even unpleasant;

• techniques that may be painful or noxious must be time limited;

• the proposed use of these techniques requires scrutiny of clinical effectiveness and

specially constituted committee review; and

on-going monitoring and safeguards must be in place during implementation of the

technique.