Community Hospital Self Assessment

Community Hospital
Self Assessment

Instructions	Licensure and Insurance	HIPAA	Employee Training	Lab	Anesthesia	Emergency Room	Risk Management
Quality Improvement	Environment of Care	Restraint Use	Infection Control	Falls Management	Patient Management	Documentation	Pharmaceutical Management

CRITERIA MEASURE	Met	Not Met	Comments	Refer to Department
Non-emergency restraints are applied only after a physician's order is received
A Physician, Physician Assistant or RN approves the application of emergency restraints within 60 minutes of application
A Physician, Physician Assistant or RN approves the application of emergency seclusion within 60 minutes of the initiation of seclusion
Any patient in restraint or seclusion receives comfort and safety checks according to hospital policy
Discontinuance of restraint or seclusion is ordered by a physician