Patient Restraint Compliance Survey

General Understanding Processing the Data

1. Are you aware of the definitions of physical and chemical restraints according to the hospital policy and federal regulations?

Yes
No

Follow-up: If No, please describe what you believe constitutes a physical or chemical restraint.

1. Can restraints be used for disciplinary purposes or staff convenience?

Yes
No

Conditions for Use

1. Under what conditions can restraints be used on a patient? (Select all that apply)

To protect the patient from imminent harm
As a convenience for staff
When other less restrictive measures are ineffective
As a disciplinary action

1. Who is authorized to order the use of restraints in your facility? (Select all that apply)

Physician
Nurse Practitioner
Any licensed practitioner permitted by state and facility regulations

1. What steps must be taken before applying restraints? (Select all that apply)

Obtain an order from an authorized practitioner
Attempt less restrictive measures
Explain the reason for restraint to the patient if possible
Document the decision-making process

Duration and Monitoring

1. Are you aware of the time limits for the use of restraints based on the patient's age group?

Yes
No

Follow-up: If Yes, please specify the maximum time limits for each age group: Adults (18+), Adolescents (9-17), Children (Under 9)

1. What must be monitored continuously when a patient is restrained? (Select all that apply)

Physical and psychological status
Behavior
Vital signs
Any signs of distress or discomfort

Documentation and Review

1. Is it required to document each use of restraints, including the reason, type, and duration?

Yes
No

1. How often must the need for continued use of restraints be reviewed?

Every 30 minutes
Every hour
At least once per shift
Daily

1. Have you received training on the proper use and documentation of restraints?

Yes
No

Scenario-Based Questions

1. A patient becomes increasingly agitated and threatens to harm themselves. You are considering the use of restraints. What steps do you take before applying restraints?

Contact the authorized practitioner
Try verbal de-escalation techniques
Document the patient's behavior
None of the above

1. A patient under restraint shows signs of respiratory distress. What is your immediate action?

Continue monitoring the patient
Immediately remove the restraint and provide necessary medical attention
Document the incident after completing your shift
Inform the patient's family first

Knowledge Assessment and Compliance Reporting

1. Are you familiar with the specific federal regulations (e.g., 42 CFR §482.13, §460.114, §483.358) that govern the use of restraints in healthcare settings?

Yes
No

Follow-up: If Yes, can you briefly describe the key principles these regulations establish?

1. Do you know the procedure for reporting and reviewing the use of restraints within your facility?

Yes
No

Follow-up: If Yes, please outline the steps involved in this process.

1. How effective do you find the current training on the use of restraints?

Very effective
Somewhat effective
Neutral
Ineffective

Follow-up: Please provide suggestions for improving training and education on restraint use.

Final Comments and Suggestions

1. Do you have any comments or suggestions regarding the use of restraints, patient safety, or related policies in your facility?