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Restraints QI
Restraints QI
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Created by Qualaris Staff
Inpatient Nursing
Critical Access Hospital
Table of Contents
Audit Form
Audit Form
Restraints QI
Required
Observed Date
Unit
ED
ICU
Med-Surg
PACU
Rehab
Shift
AM
PM
Date of assessment
Do not enter protected health information (PHI)
Restraints QI Checklist
Mark all as...
Physician's orders completed and signed
Yes
No
Q2 hr documentation on restraint flowsheet
Yes
No
