Patient Restraint & Seclusion Monitoring Checklist [FREE PDF]
Nurses and behavioral health staff use this checklist to monitor patients in restraint or seclusion per CMS Conditions of Participation 42 CFR 482.13 patient rights standards and Joint Commission PC.03.05 requirements.
- Industry: Healthcare
- Frequency: Per Event
- Estimated Time: 10-15 minutes
- Role: Registered Nurse
- Total Items: 8
- Compliance: CMS 42 CFR 482.13(e)(f), Joint Commission PC.03.05
Restraint Order & Documentation
Verify physician order, clinical justification, and time limits.
- Is there a current physician order specifying type and duration of restraint?
- Is the clinical justification for restraint documented in the patient record?
- Were less restrictive alternatives attempted and documented before restraint use?
- Order and documentation notes
Patient Monitoring & Assessment
Confirm ongoing patient assessment during restraint or seclusion.
- Are patient assessments performed at required intervals (every 1-2 hours)?
- Are circulation, sensation, and skin integrity checked at restraint sites?
- Are nutrition, hydration, toileting, and comfort needs addressed?
- Patient monitoring notes
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Why Use This Patient Restraint & Seclusion Monitoring Checklist [FREE PDF]?
This patient restraint & seclusion monitoring checklist [free pdf] helps healthcare teams maintain compliance and operational excellence. Designed for registered nurse professionals, this checklist covers 8 critical inspection points across 2 sections. Recommended frequency: per event.
Ensures compliance with CMS 42 CFR 482.13(e)(f), Joint Commission PC.03.05. Regulatory-aligned for audit readiness and inspection documentation.
Frequently Asked Questions
What does the Patient Restraint & Seclusion Monitoring Checklist [FREE PDF] cover?
This checklist covers 8 inspection items across 2 sections: Restraint Order & Documentation, Patient Monitoring & Assessment. It is designed for healthcare operations and compliance.
How often should this checklist be completed?
This checklist should be completed per event. Each completion takes approximately 10-15 minutes.
Who should use this Patient Restraint & Seclusion Monitoring Checklist [FREE PDF]?
This checklist is designed for Registered Nurse professionals in the healthcare industry. It can be used for self-assessments, team audits, and regulatory compliance documentation.
Can I download this checklist as a PDF?
Yes, this checklist is available as a free PDF download. You can also use it digitally in the POPProbe mobile app for real-time data capture, photo documentation, and automatic reporting.