Patient Restraint Monitoring Checklist - FREE PDF
Document patient restraint monitoring per CMS Conditions of Participation.
- Industry: Healthcare
- Frequency: Per CMS/policy intervals
- Estimated Time: 5-10 minutes each check
- Role: RN
- Total Items: 30
- Compliance: CMS CoP 42 CFR 482.13, Joint Commission, State Requirements
Documentation Review
Review required documentation and policies.
- Policies and procedures current?
- Staff training documented?
- Required records complete?
Practice Observation
Observe clinical practices for compliance with CMS CoP 42 CFR 482.13.
- Staff practices comply with standards?
- Required equipment/supplies available?
- Care environment appropriate?
Patient/Resident Safety
Evaluate safety measures and outcomes.
- Safety interventions in place?
- Quality outcomes monitored?
- Quality improvement actions taken?
Regulatory Compliance
Verify compliance with CMS CoP 42 CFR 482.13, Joint Commission, State Requirements.
- Regulatory requirements met?
- Any deficiencies identified?
- Deficiency Description
Corrective Actions
Document required corrective actions.
- Immediate Actions Needed
- Follow-up Actions Required
- Follow-up Audit Date
- Auditor Signature
Pre-Assessment Information
Initial assessment documentation and patient/facility identification
- Assessor Name / Credentials
- Assessment Date
- Department / Unit
- Assessment Type (Routine/Annual/Complaint)
- Previous assessment findings reviewed?
Infection Prevention & Control
Verify infection control practices per CDC and Joint Commission standards
- Hand hygiene compliance observed?
- Appropriate PPE available and properly used?
- Isolation precautions properly implemented?
- Sharps containers available and not overfilled?
- High-touch surfaces properly disinfected?
Patient Safety & Identification
Verify patient safety protocols and identification procedures
- Two patient identifiers used before procedures?
- Fall risk assessment completed?
- Call light within patient reach?
- Bed in lowest position with brakes locked?
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Why Use This Patient Restraint Monitoring Checklist?
This patient restraint monitoring checklist helps healthcare teams maintain compliance and operational excellence. Designed for rn professionals, this checklist covers 30 critical inspection points across 8 sections. Recommended frequency: per cms/policy intervals.
Ensures compliance with CMS CoP 42 CFR 482.13, Joint Commission, State Requirements. Regulatory-aligned for audit readiness and inspection documentation.
Frequently Asked Questions
What does the Patient Restraint Monitoring Checklist cover?
This checklist covers 30 inspection items across 8 sections: Documentation Review, Practice Observation, Patient/Resident Safety, Regulatory Compliance, Corrective Actions, Pre-Assessment Information, Infection Prevention & Control, Patient Safety & Identification. It is designed for healthcare operations and compliance.
How often should this checklist be completed?
This checklist should be completed per cms/policy intervals. Each completion takes approximately 5-10 minutes each check.
Who should use this Patient Restraint Monitoring Checklist?
This checklist is designed for RN 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.