Observation/Restraint Trivia

HELP THIS IS ALL SO NEW

100

What two programs are considered "acceptable" video platforms to conduct telehealth contacts

1. Microsoft Teams

2. Webex/Real Presence - Polycom

200

When is PSU responsible for completing an incident report for an observation or restraint placement?

If you place someone into observation status or restraints during business hours. 

300

Name three of the available forms of clothing/coverings that can be provided to PIOC's in observation and/or bed restraints

1. Suicide smock

2. Kilt

3. Velcro Shorts

4. Paper Gown

5. Security blanket

6. Towel

400

What specific form, in addition to the obs/restraint paperwork needs to be completed within two days of using ambulatory restraints?

A Behavior Management Plan (BMP)

500

How often does PSU review patients in the following statuses: (initially, and follow-up)

1. Observation

2. Bed Restraints

3. Ambulatory Restraints

1. Initially - Within 16 hours and then every working day

2. Initially, within 2 hours and then every 12 hours

3. Initially within 2 hours and then every working day

For an additional 100 points: How often does range of motion occur in restraints?

ARE YOU SURE THAT'S IN THE POLICY?

100

Should patients be restrained (in bed restraints) on a standard mattress or a security mat?

A regular mattress, unless a high security mattress or removal of a regular mattress is necessary

For 100 bonus points: In what situation would a removal of a mattress occur?

200

Do you have to see someone via teams within two hours if they are transitioning from bed restraints to ambulatory restraints 

No, only if they are transitioning from ambulatory restraints to bed restraints, or if it is an initial restraint placement

300

List a situation when the restraint chair can be utilized

 - As an alternative to bed restraints after all other
options have been exhausted
- To transport highly assaultive PIOCs
- temporarily for medical purposes/procedures

400

When a patient has been in clinical observation status for 15 days, what do you need to do on or before the 15th day?

AND is this 15 days total? or 15 working days?

You must read the DOC-28 to the patient. They can accept or refuse to have an advocate present, and a copy of this should be placed into their property.

this is 15 working days!!!

500

Who is responsible for determining "medically necessary" property? And where must this be documented?

HSU. HSU is responsible for documenting this on the DOC-112

PSU will document that these have been determined to be medically necessary items, and as a result will be “authorized” for the patient to have in observation status

DO I EVEN WORK HERE?

100

What three forms do we fill out for a restraint placement while on-site (both paper and EMR forms)

DOC-111

DOC-112 - You will complete the form indicating you are placing someone in bed restraints and will fill out a new DOC-112 with the box checked for "observation in restraints" documenting placement

PSU Restraint Plan and PSU Clinical Observation Plan (If this is the initial placement, you complete both Initial Restraint Review and "Place in Clinical Observation" Document. If they are already in obs, you will complete only the initial restraint review)

**do not discontinue the obs orders!

200

What forms do we fill out for a restraint placement while off-site (both paper and EMR forms)

DOC-111 - This needs to be completed virtually and uploaded into the TELEHEALTH PSU FOLDER. You are responsible for initiating this.

• Per Cpt. Marwitz, we are still completing the DOC-111 when we release someone from restraints

PSU Restraint Plan and PSU Clinical Observation Plan (If this is the initial placement, you complete both Initial Restraint Review and "Place in Clinical Observation" Document. If they are already in obs, you will complete only the initial restraint review)

**do not discontinue the obs orders!

300

What is the standard initial property for bed restraints?

Tear away shorts

Regular mattress

400

List the starting points for allowed property (7 total)

1. Suicide-Resistant clothing

2. Security mat

3. Bar or liquid soap and wash cloth

4. Bag Meals

5. Toilet paper

6. DOC-3035 

7. Crayon for completing DOC-3035

500

List three other property items that could be approved by PSU staff (hint: there are more than three)

• Security Blanket
• Mattress (regular)
• Hot Styro
• Book
• Clothing (pants, shirt, underwear, socks)
• A pillow without a pillow case

THAT IS BRAND NEW INFORMATION

100

Give an example of when ambulatory restraints may be utilized?

As a less restrictive alternative to bed/chair restraints, when the individual's primary means of self-harm involve insertion behavior, a transition out of bed restraints, in an event where a patient may have a significant wound that they could manipulate. 

200

What happens if security staff want to initiate a bed-restraint placement but you do not agree that restraints are "clinically necessary," or there are clinical contraindications

Security can initiate a security-led placement
(but we still have to do the paperwork and
 review) - They determine when release is appropriate

Security supervisor should authorize removal if there are clinical contraindications
(if they disagree, Warden and medical director
will review)

300

If someone is placed into clinical observation status and WILL NOT be housed in an observation cell (i.e. all the obs cells are full), what type of monitoring (i.e. frequency of checks) should be utilized. 

And, in the event that a "camera cell" is open, can this be used as a substitute for monitoring the patient?

5- minute checks

and NO!!!!!!!!!!!!!!!! 

400

When an observation placement is suspended (i.e. go out on a hospital trip) do you need to start a new DOC-112/observation paperwork upon their return? AND do you need to see them?

No, but you should document the time of suspension and the time of return in a case management note

And no, unless there is a change in status (i.e. being placed into bed restraints)

500

You placed a patient into bed restraints at 7am. At 5pm, a security supervisor contacts you to do the review early, as they are completing range of motion at that time. You review the patient at 5pm and determine that they will remain in bed restraints. What time is the next PSU review?

5am. The review must occur within 12 hours of the last review.

YOU FEELING LUCKY, PUNK?

100

If someone engages in self-harm behavior (regardless of intention- like punching a wall out of anger, do you have to place them in clinical observation status?

• You must personally evaluate the individual before you can recommend placement other than clinical observation unless a PSU supervisor or BMP cosigned by PSU supervisor directs otherwise
• Per Dr. Larson “The first step would be to determine how we know that the self-harm occurred in the past – is this info reliable? For example, is that info from HSU? Security? Self report? Next, what do we know about the person’s self harm history or mental health state? If a person engaged in self-harm behavior and we don’t know that person, what is the level of risk to not evaluating his risk? Was the behavior part of rehearsal of a larger attempt? Was it to manage emotions, etc.? Will there be a plan for follow up? In a lot of cases when it’s determined that an observation placement will not be made it seems there also is not a follow up assessment scheduled? Then we would have a person who we know self-harmed that then receives no assessment…We added the part about consulting with the supervisor/BMP to allow for the use of clinical judgement with approval of the supervisor in these cases. In most cases I suspect that the consult would end with the person not being placed in observation with reasons documented. My hope would be that these notes would also include a statement related to follow up if relevant.

200

A patient is placed into clinical observation status on 11/12/25. They are sent out to the hospital on 11/14/25 and do not return to DCI until 11/19/25. What "Day in observation" (i.e. day 1, day 2, day 3) would the review on 11/19/25 be? 

DAY 6!

300

Security places a patient into control status. Based on this status they will be housed in cell 26 and approved to have tear-away shorts and a mat. While in control status, the patient bangs his head on the door and states he is suicidal.

Do you place them in observation status even though they are already in control and have the obs property?

Do you give them a smock?

YES. They do not have to change cells nor will their property change.

NO (unless there's a good reason to authorize a smock over tear-away shorts)

400

If a patient needs to go to the hospital for an offsite trip but are currently in ambulatory restraints, are you able to suspend this? and if so, when they return do you need to see them for a restraint review?

Yes, you can suspend this placement. If they have not been reviewed for their restraint review on that working day, you would need to see them, however, if you have already reviewed them that day, you do not need to see them upon their return (this is similar to an observation suspension).

500

Patient Smith was placed into bed restraints on Monday at 10pm from unit 22 after banging his head repeatedly.

It is determined by HSU that he will be sent out to the hospital at 2am after biting his lip and spitting blood.

He returns from the hospital at 10am on Wednesday.

Please list the steps you would take (i.e. completing the restraints review, orders in EMR, etc.)

- Complete initial restraints review by 12am via telehealth and complete DOC-111. Save this in the telehealth PSU folder

Initiate obs order and restraint order and complete initial obs/restraints paperwork in EMR

Complete review of restraints by 12pm Wednesday, after he returns from hospital in person. Complete DOC-111, DOC-112 and EMR documentation.

Check the tasks complete for the obs reviews on Tuesday and Wednesday.