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Run: Seclusion and Restraint Episode Documentation

Document a seclusion or restraint episode with the behavior, de-escalation attempts, monitoring, and debriefing needed for a clear compliance record.

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Submission Notice

Documentation notice

Episode Details

Date of episode (required)

Start time (required)

End time

Episode type (required)

Location (required)

Document the unit, room, or area where the episode occurred.

Staff role initiating the episode (required)

Enter the role or title only; do not enter unnecessary personal identifiers.

Precipitating Behavior and Risk

Behavior leading to seclusion or restraint (required)

Describe observable actions and statements. Avoid speculation or diagnostic labels.

Immediate safety risk (required)

Other risk details

Less-Restrictive Measures Tried

Measures attempted before seclusion or restraint (required)

Were the less-restrictive measures effective? (required)

Why escalation was needed

Explain why less-restrictive measures were insufficient.

Other measures details

Seclusion or Restraint Details

Restraint type

Authorizing provider role

Enter the provider role/title only if required by policy.

Authorization time

Duration in minutes

Other restraint details

Monitoring and Patient Response

Monitoring frequency (required)

Were vital signs monitored? (required)

Patient response during episode (required)

Document observable response, including signs of distress, calming, or escalation.

Any injury or adverse event? (required)

Injury or adverse event details

Debriefing and Follow-Up

Was a debriefing completed? (required)

Debriefing participants

Follow-up actions

Document care plan updates, safety planning, referrals, or monitoring changes.

Audit trail notes

Optional notes for compliance review, including any late entry or correction details.

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Email (required)

Your name (optional)

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