This customizable document, Restraint Order Sheet, is taken from MCN Healthcare’s Intensive Care Unit Policy and Procedure Manual. For more than 20 years, MCN has been the health care industry’s leading provider of policy and procedure templates, forms, competencies and other compliance tools.

MCN provides more than 80 health care specific policy and procedure manuals for Acute Care Hospitals, Ambulatory Care, Behavioral Health, Home Health, Physician Practice, and Long Term Care. MCN’s policy and procedure manuals focus on the latest healthcare "hot topic" issues related to patient safety and prevention of medical healthcare errors.

Here is some sample content from Restraint Order Sheet:

	RESTRAINT ORDER SHEET Behavior Requiring Restraint Type of Restraint q Confusion/disorientation/combative q Hallucination q Removing medical devices q Other specify q Soft wrist/ankle q Halter type vest q Seat belt q Other specify ? Less restrictive measures as indicated on Behavior Restraint Flow Sheet attempted and unsuccessful. ? Use of restraints are clinically indicated. Duration: ? Until behavior resolves - max 24 hours Acute Units Date: Behavior Requiring Restraint Type of Restraint q Confusion/disorientation/combative q Hallucination q Removing medical devices q Other specify q...
Second excerpt:
	...Halter type vest q Seat belt q Other specify ? Less restrictive measures as indicated on Behavior Restraint Flow Sheet attempted and unsuccessful. ? Use of restraints are clinically indicated. Duration: ? Until behavior resolves - max 24 hours Acute Units Date: Behavior Requiring Restraint Type of Restraint q Confusion/disorientation/combative q Hallucination q Removing medical devices q Other specify q Soft wrist/ankle q Halter type vest q Seat belt q Other specify ? Less...