LIP Restraint Note

Patient placed in [checkbox value="escort|moab|child hold|then directly into moab"] due to [checkbox value="aggressive behavior|self-harm|property destruction with the potential to result in injury to self or others|attempt to elope|need for administration of medications"][text memo="free text option" size="20"] from [text memo="time in" size="8"] to [text memo="time out" size="8"].  Report occurred with RN [checkbox value="in person |over the phone "][checkbox value="during the restraint|after the restraint"] at [text memo="time of report" size="8"]. [checkbox value="Patient examined in person within 30 minutes of the restraint.  "][checkbox value="Patient calmed without medication intervention.  |Patient received scheduled medications.  |Patient received PRN medications.  "][checkbox value="Per psychiatric emergency patient received "][checkbox value="oral medications.  |IM medications.  "][checkbox value="Patient is free of injury following restraint.  |Patient sustained injury to the "][text memo="location of injury if applicable" size="20"][checkbox value=" as a result of the restraint| as a result of the aggressive behavior| as a result of the self-injurious behavior|which was examined by this LIP|which was examined by nursing staff|which was examined by FNP|and does not require medical attention. |and required medical attention. "][checkbox value="There were no reported injuries to staff leading up to or in the process of the restraint. |Injuries to staff occurred in the nature of "][text memo="Injury to staff if applicable" size="20"] The patient is now [checkbox value="resting in their room quietly.|taking space in their room away from the milieu.|engaging in sensory activities.|reengaged safely in the milieu.|isolated from the milieu due to continued safety risk."][checkbox value=" The patient continues to struggle with emotional reactivity and poor frustration tolerance. "] [textarea memo="additional information if applicable" cols="50" rows="3"]
[text memo="LIP name" size="15"]