b'Repetitive Self-Mutilating BehaviorPrior to Order ExpirationIf a patient is diagnosed with a chronic medical orRN will notify practitioner directly and advise them of psychiatric condition and the patient engages in thethe upcoming expiration time beginning on hour 21 repetitive self-mutilating behavior, a standing or PRN orderfrom when the order was placed and Q subsequent hour for restraint to be applied in accordance with specificafter, until order is addressed. RN should document parameters established in the treatment plan would becommunication. permitted. Since the use of restraints to prevent self-injury is needed for these types of rare, severe, medical andRN will personally notify the CC of expiration time psychiatric conditions, the specific requirements below forAn assessment by RN and LIP to evaluate the need for the management of violent or self-destructive behavior docontinued restraint must be done prior to every renewal not apply: order. Documentation and updated IPOC is required in the Face to faceEMR for each renewalTime limited orders When possible, ensure one practitioner is entering Evaluation every 24 hours before renewal of the order restraint orders per patient to avoid multiple renewals in the same 24-hour periodStandard Requirements Non-violent (Medical) Violent (Behavioral) SeclusionPatient Safety Plan (upon admission) N/A X XInitiation of R/S Emergency application,Emergency application,Emergency application, as necessary as necessary as necessaryOrder for R/S During or immediatelyDuring or immediatelyDuring or immediately (within a few minutes) (within a few minutes) (within a few minutes)Order signed by QLP (if verbal orWithin 24 hours Within 24 hours Within 24 hourstelephone)Notification of Nursing Leadership [Operations Administrator (OA)/ X X XDirector]Initial Nursing Documentation X X X12 years of age and under: Direct observation (face-to face or seclusion Continuous Nursing Monitoring andwindow) for first Documentation Every 2 hours Every 15 minutes hour and at least every 15 minutes thereafterOver 12 years of age: Every 15 minutesRN Evaluation Every 2 hours Every 60 minutes Every 60 minutesPlan of Care X X XAs soon as possible, butAs soon as possible, but Debriefing Within 24 hours no longer than with 24no longer than with 24 hours ofR/S releasehours of release from from R/SNCH Policy Description: Restraint and Seclusion v62022 Survey Readiness Guide 33'