Patient Restraint Assessment & Monitoring Checklist
FREE patient restraint assessment and monitoring checklist with CMS and Joint Commission compliance. Covers restraint justification, alternatives, patient monitoring, and documentation. Multi-market standards for US CMS/Joint Commission, UK CQC/MHA, India NABH, Brazil CFM, Mexico NOM, and Colombia regulations. Download FREE PDF with 40+ monitoring points.
- Industry: Healthcare
- Frequency: Per Restraint Episode
- Estimated Time: 10-15 minutes initial, ongoing monitoring
- Role: Operations Manager
- Total Items: 30
- Compliance: CMS CoP Restraint Use, Joint Commission Standards, 42 CFR 482.13, UK CQC Restraint Standards, UK Mental Health Act
Clinical Justification
Documentation of restraint necessity.
- Specific behavior requiring restraint documented?
- Immediate safety risk identified?
- Type of Risk
- Least restrictive effective intervention?
Alternatives Attempted
Document alternatives tried before restraint.
- Verbal reorientation/de-escalation attempted?
- Family/sitter presence tried?
- Diversional activities offered?
- Environment modified (lower bed, lighting)?
- Medications reviewed for alternatives?
- Basic needs addressed (pain, toileting, hunger)?
- Why alternatives ineffective?
Physician Order
Verify proper ordering.
- Physician order obtained?
- Order time-limited per policy?
- Face-to-face evaluation documented (if violent)?
- Plan for order renewal/discontinuation?
Safe Application
Proper restraint application.
- Correct size restraint applied?
- Applied with proper technique?
- Circulation checked after application?
- Quick release knots used?
- Tied to bed frame (not side rails)?
Ongoing Monitoring
Required monitoring intervals.
- Visual check every 15 minutes?
- Circulation/skin check every 2 hours?
- Range of motion every 2 hours?
- Toileting offered regularly?
- Hydration and nutrition addressed?
- Ongoing assessment for discontinuation?
Infection Prevention & Control
Infection control per CDC/Joint Commission
- Hand hygiene compliance observed?
- Isolation precautions followed correctly?
- Sharps containers not overfilled?
- Appropriate PPE available and used?
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Why Use This Patient Restraint Assessment & Monitoring Checklist?
This patient restraint assessment & monitoring checklist helps healthcare teams maintain compliance and operational excellence. Designed for operations manager professionals, this checklist covers 30 critical inspection points across 6 sections. Recommended frequency: per restraint episode.
Ensures compliance with CMS CoP Restraint Use, Joint Commission Standards, 42 CFR 482.13, UK CQC Restraint Standards, UK Mental Health Act, India NABH Standards, Brazil CFM Restraint Guidelines, Mexico NOM-025-SSA2, Colombia Resolución 2003/2014. Regulatory-aligned for audit readiness and inspection documentation.
Frequently Asked Questions
What does the Patient Restraint Assessment & Monitoring Checklist cover?
This checklist covers 30 inspection items across 6 sections: Clinical Justification, Alternatives Attempted, Physician Order, Safe Application, Ongoing Monitoring, Infection Prevention & Control. It is designed for healthcare operations and compliance.
How often should this checklist be completed?
This checklist should be completed per restraint episode. Each completion takes approximately 10-15 minutes initial, ongoing monitoring.
Who should use this Patient Restraint Assessment & Monitoring Checklist?
This checklist is designed for Operations Manager 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.