Larkin Community Hospital - Competency Checklist - Restraint And Seclusion Page 2

Documents appropriately, referencing the protocol as needed

Monitors patient at least every two (2) hours while restrained, and assess

patient as above

5. Demonstrates competence in patient assessment every one (1) hour while

restrained for medical reason.

State examples of reason for medical restraint

Sates required assessment criteria

Nutrition / Hydratation

Circulation / Range of motion

Hygiene

Elimination

Physical status and comfort

Psychological status and comfort

6. Documents appropriately utilizing the LCH – RESTRAIN Doc. Assessment and

debriefing forms in HMS.

o

Employee is competent to perform the above tasks independently and without supervision

o Employee’s level of competence is below 2. Reassess competency on:_______________________________________

Employee’s Signature

Evaluator’s Signature

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Parent category: Life