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Restraint assessment form

Restraint assessment form 2025

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The document outlines the procedures and guidelines for the monitoring and documentation of restraint and seclusion in a behavioral health setting in Milwaukee, Wisconsin. It includes details on the initiation of restraints, required documentation, assessment intervals, types of restraints, and the responsibilities of healthcare providers in ensuring patient safety and compliance with legal standards.

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Click ‘Get Form’ to open the restraint assessment form in the editor.
Begin by filling in the 'Initiation of Restraints' section. Enter the date and time when restraints were initiated, along with the reason for restraint, ensuring it aligns with behavioral criteria.
Document family notifications and provide information regarding the restraint's purpose and release criteria. Use initials to confirm these actions.
In the 'Type of Restraint Key', select appropriate restraint types based on patient age and condition. Fill in each corresponding hour and minute as required.
Complete monitoring sections every 15 minutes, documenting physical responses, orientation status, and readiness for release. Ensure to initial each entry for accountability.
Finally, document any exceptional observations in the designated area, providing thorough details as necessary before concluding with discontinuation documentation.

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How often must a patient on restraints be assessed?

A qualified nurse will do the following: Patients with Violent or Self-Destructive Behavior Restraints must be assessed by a qualified nurse at least every two hours and interventions implemented as indicated.

What should be considered in the assessment for restraint?

Assessment should include factors such as physical illness, pain, side effects of drugs, psychological issues and consideration of a medical assessment the potential and/or actual risks to the service user and others eg if bed rails were being considered as an option, was the persons ability to climb up and fall

How do you document restraints?

The flowsheet should include the following: patient behavior that indicates the continued need for restraints patients mental status, including orientation number and type of restraints used and where theyre placed condition of extremities, includ- ing circulation and sensation extremity range of motion

Which finding would be included in restraint assessment documentation?

Documentation of the restraint and seclusion episode should include: The events and behavior that led to the use of seclusion or restraint. Non-physical and least restrictive interventions that were attempted and the persons response.