Audit 1

Staff Member Name

Question: How have u provided care for your patient today?

Target Concept - Did they say:

Was information obtained about medical/physical conditions placing patient at increased physical risk during restraint/seclusion. History of sexual or physical abuse that would place patient at increased psychological risk during restraint/seclusion. Techniques or tools to help patient regain control, including family when appropriate. PC.03.03.11 EP5

Key Concept:

Initial RN assessment
H&P
Crisis assessment (in Psych ED)

Response

Related Policies

Question: We're any patients physically held or placed in restraints or seclusions for behavioral reasons?

Target Concept - Did they say:

Is patient's dangerous behavior documented in chart? PC.03.03.11
Are non-physical interventions which were attempted documented? PC.03.03.11
Have patients in restraint or seclusion had continuous in-person monitoring by staff and 15-minute assessments documented in the patient chart?
PC.03.03.23 EP2 PC.03.03.25 EP1

Key Concept:

Behavioral Restraint Flowsheet

Response

Related Policies

Question: Are orders for patients in physical hold, restraint or seclusion obtained?

Target Concept - Did they say:

Are orders received from the LIP within 1 hour of initiation? PC.03.03.13 EP2
Are orders time limited based on patient age? PC.03.03.15 EP1
Was a new order obtained as needed appropriate to the time limit on the original order? PC.03.03.17 EP3

Key Concept:

Orders

Response

Related Policies

Question: (For Behavioral restraints in behavioral health units only) We're any patients physically held or placed in restraints or seclusions for behavioral reasons?

Target Concept - Did they say:

What training do you receive related to minimizing the use of restraint/seclusion and for maximizing patient safety when they are used?
PC.03.0307 EP1, EP2, EP3, EP4, EP5, EP6

We're clinical leaders informed if a patient remained in restraint or seclusion for more than 12 hours, or if 2 or more episodes of restraint or seclusion incurred within 12 hours?
PC.03.03.21 EP1

Was the restraint/seclusion discontinued when the patient met criteria for discontinuation?
PC.03.03.27 EP2

Did staff and patient debrief following restraint or seclusion? As appropriate, was the patient's family debriefed?
PC.03.03.29 EP1

Key Concept:

De-escalated and aggression management training(ex. SAMA)
Collaborative problem solving training
Restraint/seclusion training

Behavioral restraint Flowsheet

Response

Related Policies
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.