MO SB858

Allows advanced practice registered nurses (APRNs) in collaborative practice arrangements with physicians to authorize physical or chemical restraint, isolation, or seclusion in mental health facilities when determined imminently necessary for patient safety.

Requires physician review of APRN-issued restraint orders within 4 hours for patients under 18 years old or within 8 hours for patients 18 and older if restraint extends beyond those timeframes.

Mandates all uses of restraint, isolation, or seclusion be documented in the clinical record with the signature of the facility head, attending physician, or APRN in collaborative practice arrangement.

Requires in-person review of APRN-issued orders by an attending physician within 24 hours or the next regular working day, with documentation in the clinical record.

Clarifies that security escort devices used during transport outside facilities are not considered physical restraint and may be used based on detention classification and physician determination of necessity.