Patient Restraint Assessment & Monitoring Checklist
Document comprehensive assessment and ongoing monitoring of patients in restraints per CMS Conditions of Participation and Joint Commission standards.
- Industry: Healthcare
- Frequency: Every 2 hours / Per policy
- Estimated Time: 10-15 minutes
- Role: Nurse
- Total Items: 28
- Compliance: CMS CoP 42 CFR 482.13, Joint Commission PC.03.05.01-17, State Regulations
Order Verification
Verify valid restraint order
- Current valid restraint order in place?
- Order within time limits (4h adult, 2h peds)?
- Physician face-to-face within 1 hour (if behavioral)?
- Least restrictive restraint being used?
Physical Assessment
Patient physical status
- Circulation to extremities adequate?
- Skin integrity intact under/around restraint?
- Range of motion maintained?
- Vital signs within acceptable limits?
- Nutrition/hydration needs addressed?
- Elimination needs addressed?
Behavioral Assessment
Patient behavioral status
- Current behavior documented?
- Orientation level assessed?
- Patient response to restraint documented?
- Agitation/anxiety level assessed?
Alternatives Considered
Less restrictive alternatives
- Verbal de-escalation attempted?
- Environmental modifications considered?
- Family presence considered?
- Distraction techniques attempted?
- Continued need for restraint documented?
Restraint Device Check
Device safety verification
- Restraint properly applied?
- Two-finger space under restraint?
- Quick-release knots used?
- Tied to bed frame (not rails)?
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?
Related Healthcare Checklists
- Hand Hygiene Compliance
- Medication Safety Check
- Surgical Safety Checklist
- Fall Prevention Assessment
- Joint Commission Readiness
- HIPAA Compliance Audit