Patient Restraint Monitoring Checklist - FREE PDF
Monitor restrained patients per regulatory requirements.
- Industry: Healthcare
- Frequency: Every 2 hours
- Estimated Time: 5-10 minutes
- Role: Nursing
- Total Items: 32
- Compliance: CMS CoP, Joint Commission PC.03.05.01, State Regs
Compliance Review
Review CMS CoP requirements.
- Policy and procedure followed?
- Documentation complete and accurate?
- Regulatory requirements met?
Process Verification
Verify process implementation.
- Staff competent in process?
- Required equipment/supplies available?
- Process effective for patient safety?
Patient/Resident Impact
Assess impact on patient care.
- Patient safety maintained?
- Patient dignity and rights respected?
- Patient satisfaction addressed?
Findings & Corrective Actions
Document audit findings.
- Audit Result
- Deficiencies Found
- Corrective Actions Required
- Follow-up Required?
- 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?
Medication Safety & Management
Verify medication handling and administration practices
- Medications stored securely and at proper temperature?
- Controlled substances properly secured and counted?
- No expired medications in stock?
- High-alert medications properly labeled?
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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 nursing professionals, this checklist covers 32 critical inspection points across 8 sections. Recommended frequency: every 2 hours.
Ensures compliance with CMS CoP, Joint Commission PC.03.05.01, State Regs. Regulatory-aligned for audit readiness and inspection documentation.
Frequently Asked Questions
What does the Patient Restraint Monitoring Checklist cover?
This checklist covers 32 inspection items across 8 sections: Compliance Review, Process Verification, Patient/Resident Impact, Findings & Corrective Actions, Pre-Assessment Information, Infection Prevention & Control, Patient Safety & Identification, Medication Safety & Management. It is designed for healthcare operations and compliance.
How often should this checklist be completed?
This checklist should be completed every 2 hours. Each completion takes approximately 5-10 minutes.
Who should use this Patient Restraint Monitoring Checklist?
This checklist is designed for Nursing 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.