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Is the person being disruptive
| YES
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Is the person being physically disruptive
| YES
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Call security to help disrupt the situation
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NO
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NO
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YES
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No need for intervention
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Has the person verbally threantened you, themselves, or anyone else
| YES
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Is the person under the influence of a substance
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NO
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Can the patient be calmed down by you or other staff nurses
| YES
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Calm the person and reassess the problem
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NO
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Call security to help disrupt the situation
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