Seclusion and Restraint Episode Documentation

Documents the behavior leading to seclusion or restraint, less-restrictive interventions attempted, monitoring during the episode, and post-episode debriefing for regulatory compliance.

Submission Notice

• What happens after I submit?
  The submission is stored in the episode record, added to the audit trail, and routed to the appropriate clinical reviewer if follow-up is required.
• Documentation and privacy notice
  This form may include protected health information (PHI) and should be completed only by authorized staff. Enter only information necessary for care, safety, and compliance.

Episode Details

• Date of episode
• Start time
• End time
  Enter when the episode ended, if known at the time of documentation.
• Location
• Episode type
• Restraint type
• Describe other restraint type

Precipitating Behavior and Risk

• Behavior leading to the episode
  Describe the observable behavior, not conclusions or labels.
• Immediate safety risk
• Describe other immediate risk
• Known triggers or antecedents
  Include only relevant factors observed or reported immediately before the episode.

Less-Restrictive Measures Attempted

• Less-restrictive measures attempted
• Describe other measures attempted
• Why were the measures not effective?
  Describe the observed response and why escalation was still necessary.

Monitoring During Episode

• Monitoring frequency
• Vital signs monitored?
• Monitoring notes
  Include breathing, circulation, level of distress, responsiveness, and any safety concerns.
• Any injury observed?
• Describe injury

Release, Debriefing, and Follow-Up

• Criteria for release met?
• Reason for release
• Patient response after release
  Describe behavior, emotional state, and ability to re-engage safely.
• Debriefing completed?
• Debriefing summary
• Follow-up actions
• Describe other follow-up actions