Larkin Community Hospital - Competency Checklist - Restraint And Seclusion
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1
2Competency Checklist
Date:
Employee Name:
Preceptor/Evaluator’s Name
Competency:
Restraint and Seclusion
INDICATORS OF PERFORMANCE LEVEL SUMMARY
How Met
Level of Competency
O
Direct Observation/Return Demonstration
1
Below expected standards
V
Verbalization/Discussion
2
Fully meets standards
T
Test
3
Well above standards. May precept peers
NA
Not applicable
If overall performance or competency is rated below the minimum competency level of 2, that performance or competency
must be reassessed within 30 days of this review.
How
Level of
Evaluated
The employee demonstrates skills and competence in the following:
Met
Competency
by:
1 2 3
o
Reviewed “Restraint and Seclusion” policy N
ADM-905-190
1.Physically applies and releases restraint appropriately
a.
Soft wrist restraint
b.
Hard wrist restraint
c.
Hard leg restraint
2.Demonstrates understanding of
a.
Appropriate restraint orders, including time-frames per hospital policy
b.
Underlying causes of behaviors exhibited by patients
c.
Behaviors exhibited due to medical conditions, (can cite examples of
disease processes causing these behavior)
d.
Describe how employee’s own behavior can affect the behavior of the
patient
3.Demonstrates competence in patient assessment every 15 minutes while restrained
for behavioral reasons
a.
Taking and interpreting vital signs relevant to physical safety of patient
b.
Recognition of nutrition/hydration needs
c.
Checking circulation and range of motion
d.
Addresses patient’s hygiene needs
e.
Addresses elimination needs
f.
Addresses physical status and comfort
g.
Addresses psychological status and comfort
h.
Recognizes patient’s readiness for discontinuation of restraint
i.
Recognizes when to contact a medically trained licensed independent
practitioner or emergency medical services in order to evaluate and/or
evaluate and/or treat the patient’s physical status
j.
Recognizes signs of incorrect application of restraint
4.Demonstrates competency in utilizing restraints as part of a Intubation protocol
and only when clinically justified
1
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Parent category: Life