Restraint seclusion assessment log 2025

1. Click ‘Get Form’ to open the restraint seclusion assessment log in the editor.
2. Begin by entering the CLIENT NAME and DATE OF AUDIT at the top of the form. This information is crucial for tracking and accountability.
3. Fill in the CHART/CASE # and DATE OF ADMISSION to ensure proper identification of the patient’s records.
4. In the CHART/RECORD REVIEW section, document the PHYSICIAN’S ORDER details, including TYPE, MAXIMUM TIME, and whether it was WRITTEN or VERBAL. Provide a REASON for restraint and describe the POSITION of the person restrained.
5. Record LENGTH OF TIME IN by filling in both IN and OUT times accurately to maintain a clear timeline.
6. Document the TIME OF PHYSICIAN’S ORDER along with a justification for its necessity.
7. Note any ATTEMPTS made to keep the client in a least restrictive setting, especially during emergencies.
8. Indicate how often ORDERS are RENEWED (e.g., every few hours) to comply with regulations.
9. Ensure that observations of the patient in seclusion/restraints are documented every 15 minutes as required.
10. Complete INTERDISCIPLINARY NOTES/ORDERS reflecting rationale for S&R, focusing on protection from self-injury or injury to others.
11. Finally, check if there are PRN or STANDING ORDERS for seclusion/restraints and fill out any relevant treatment plans addressing risk factors and intervention strategies.

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