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(MARCH 12ORANGE) EDEN PRAIRIE SCHOOLS DISTRICT 272 Use of Restrictive Procedures Documentation Form Student Name Grade Site Date of Crisis / / STAFF MEMBERS INVOLVED Person completing form: name,
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How to fill out use of restrictive procedures

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How to Fill Out Use of Restrictive Procedures:

01
Begin by assessing the individual's behavior and determining if the use of restrictive procedures is necessary. Consider factors such as safety concerns, the individual's ability to self-regulate, and the potential impact on their quality of life.
02
Consult with a multidisciplinary team, including healthcare professionals, therapists, and caregivers, to gather information and perspectives on the individual's needs and potential alternatives to restrictive procedures.
03
Familiarize yourself with the relevant guidelines, regulations, and legal requirements related to the use of restrictive procedures in your jurisdiction. This ensures that you are completing the documentation accurately and following the necessary protocols.
04
Create a comprehensive plan detailing the specific restrictive procedures that will be used, including the rationale behind their use and any necessary de-escalation techniques or interventions to minimize their occurrence.
05
Clearly outline the roles and responsibilities of each team member involved in implementing and monitoring the use of restrictive procedures. This includes training requirements, documentation responsibilities, ongoing assessment procedures, and reporting mechanisms.
06
Provide thorough education and training to all individuals involved in the implementation of restrictive procedures, including caregivers, staff members, and the individual themselves (when appropriate). This training should cover the risks and benefits, alternatives, proper techniques, and potential side effects.
07
Develop a system for regularly reviewing and reassessing the use of restrictive procedures. This ensures that they are always justified based on the individual's current condition and are being employed in the least restrictive manner possible.
08
Maintain accurate and detailed documentation of each use of restrictive procedures, including the date, time, duration, circumstances, alternatives attempted, and any outcomes. This documentation is crucial for monitoring effectiveness, identifying patterns or trends, and ensuring compliance with regulatory requirements.

Who Needs Use of Restrictive Procedures:

01
Individuals with severe mental health conditions that may result in self-harm or harm to others.
02
People with developmental disabilities who have difficulty controlling their behaviors and require additional support.
03
Individuals with dementia or Alzheimer's disease who experience agitation or aggressive outbursts that pose a risk to themselves or those around them.
04
Patients in medical or psychiatric crisis situations where the use of restrictive procedures may be necessary to prevent harm or provide immediate intervention.
05
Individuals with certain neurological conditions or traumatic brain injuries that impair their ability to control impulsive behaviors or respond to triggers appropriately.
Remember, the use of restrictive procedures should always be approached as a last resort and should only be used when all other less restrictive interventions have been exhausted or deemed ineffective.
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Restrictive procedures are used to manage behaviors that pose a risk to the individual or others in a structured and controlled manner.
Professionals working in healthcare, education, or other settings where restrictive procedures may be necessary.
The use of restrictive procedures should be documented accurately, including the justification, implementation steps, and monitoring process.
The purpose is to ensure the safety of individuals by using the least restrictive methods possible to manage challenging behaviors.
Information such as the reason for implementation, duration, frequency, outcomes, and any alternatives considered.
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