Case manager assessment list

Sacred Heart Hospital in Pensacola, FL, includes these elements in its assessment of patients in restraints:

• Prior to use of a restraint, evaluation of the patient’s condition is documented.

• Prior to use of a restraint, alternative measures are documented.

• Adequate justification for restraint use, such as the patient threatening himself or others, is documented.

• A time-limited order for restraint use is written within 24 hours of applying the restraint.

• The order has a specific start and end time not exceeding 24 hours.

• A restraint order is obtained for each consecutive 24 hours that restraints are applied.

• Documentation shows periodic observations of the patient’s clinical condition, such as limb circulation, and attention to patient needs, such as hydration and toileting.

• If restraints will be used for 72 continuous hours, the documentation must show a conference with independent practitioners considering changes in medications, medication doses, or behavioral interventions.

• Restraints are inspected for appropriate placement, such as the use of knots easily released in an emergency.