While on inpatient, you may be asked to order both Seclusion and Restraint orders on patients. Joint Commission audits each and every restraint or seclusion as a high-risk event. To meet compliance, you must place the order within one hour of the start of event. No need to list a co-signer. If questions, ask nursing for assistance with orders and/or notes.
Seclusion: When patient is placed in a room in which they perceive that they cannot leave (not necessarily locked).
- Two types of seclusion orders for our purposes:
- Age 8 and Younger
- Age 9 to 17
- Under orders, search with term “seclusion”
- In the “Comments” section of the Order, document the start time of the seclusion (should match exactly with start time documented by nursing) and describe the behavior that prompted the order.
Restraint: When a patient is placed in physical restraint (this includes a brief physical hold, which is commonly used on 4W). → See flow chart below
- Immediate situation: Patient pacing hallway, yelling and pounding on other patients’ doors
- Reaction to intervention: agitated, aggressive, unable to follow verbal instructions
- Medical and behavioral condition: Behaviorally agitated and aggressive, yelling loudly. Medically stable at this time.
- Need to continue or terminate the restraint or seclusion: Continue seclusion due to ongoing aggressive agitation and inability to cooperate at this time.
- If the ordering provider is not the Attending of record, an in-basket notice for co-signature will automatically be sent to the Attending. The order will be active even without attending co-signature.
- Don’t forget to make sure you have selected the button to identify if the patient is “age 8 or younger” or “age 9 to 17”
- For all restraint types, be sure you document the exact time the restraint started in the order (the RN will provide you this information).
- If the restraint or seclusion has concluded by the time you evaluate the patient, document in the order how long the restraint/seclusion lasted for.