CA DRC Patients Rights Office Seclusion and Restraint Audit Form 2008-2025 free printable template

General Acute Psych 24 Hour Care IMD/SNF/MARC/PhD PATIENTS RIGHTS OFFICE SECLUSION AND RESTRAINT AUDIT FORM CLIENT NAME: DATE OF AUDIT: CHART/CASE #: DATE OF ADMISSION: FACILITY: DATE OF SECLUSION/RESTRAINT:

How to fill out restraint seclusion assessment log

How to Fill Out Restraint Seclusion Assessment Log:

1. Start by filling out the date and time of the incident in the designated fields.
2. Clearly identify the patient's information, including their full name, date of birth, and unique identifier, such as a medical record number.
3. Document the reason for the restraint or seclusion and provide a brief description of the incident that led to its implementation.
4. Record the names and designations of the staff members involved in the incident, including those who authorized and applied the restraint or seclusion.
5. Note the type of restraint or seclusion used, whether it is physical, mechanical, or pharmacological, and provide specific details if applicable.
6. Monitor and record the patient's vital signs throughout the duration of the restraint or seclusion, including blood pressure, heart rate, respiratory rate, and oxygen saturation levels.
7. Assess and document the patient's physical and emotional status at regular intervals, noting any changes or concerns observed.
8. Keep track of the length of time the restraint or seclusion was in place, starting from the time it was initially applied until it was removed.
9. Include any actions taken to de-escalate the situation or alternative interventions attempted before resorting to restraint or seclusion.
10. Sign and date the assessment log once all necessary information has been recorded.

Who Needs Restraint Seclusion Assessment Log:

1. Healthcare facilities such as hospitals, psychiatric units, and long-term care facilities that utilize restraints and seclusion as a means of patient management.
2. The log serves as a crucial documentation tool for healthcare providers, administrators, and regulatory agencies to ensure proper adherence to restraint and seclusion protocols.
3. In addition, the log can be valuable for legal purposes, quality improvement initiatives, and oversight organizations concerned with patient safety and rights.

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What is restraint seclusion assessment log?

Restraint seclusion assessment log is a document used to track any instances of restraint or seclusion used on individuals.

Who is required to file restraint seclusion assessment log?

Healthcare facilities and organizations that use restraint or seclusion techniques are required to file the assessment log.

How to fill out restraint seclusion assessment log?

The log must be filled out with detailed information about each instance of restraint or seclusion, including the date, time, reason, duration, and any follow-up actions taken.

What is the purpose of restraint seclusion assessment log?

The purpose of the log is to track the use of restraint or seclusion techniques, ensuring they are used appropriately and to identify any potential issues or trends.

What information must be reported on restraint seclusion assessment log?

Information such as date, time, reason for use, duration, staff involved, individual's response, and any follow-up actions must be reported on the log.