Purpose: To help identify patients at risk for elopement and provide guidelines for interventions to provide a safe environment and hospitalization.

Transcription

1 University of Kentucky / UK HealthCare Policy and Procedure Policy # A Title/Description: Elopement of Pediatric and Adult Patients Purpose: To help identify patients at risk for elopement and provide guidelines for interventions to provide a safe environment and hospitalization. Policy Procedure Assessment of Risk Factors for Elopement Interventions for Patients at Risk for Elopement Response to Elopement Documentation References Persons and Sites Affected Policies Replaced Effective Date Review/Revision Dates Addendum A: Tips for Communicating With an Elopement Patient Addendum: BRISK ASSESSMENT ELOPEMENT ALGORITHM Policy Any patient identified at risk for elopement shall receive an initial and ongoing assessment and interventions pursuant to the attached Addendum A, Tips for Communicating with an Elopement Patient, and Addendum B, Risk Assessment Elopement Algorithm. Procedure Assessment of Risk Factors for Elopement Assessment of patients shall occur on admission, and if the patient is assessed to be an elopement risk upon admission elopement risk shall be assessed once each shift, or at least every12 hours. A patient is at risk for elopement if one or more of the following exist: 1. The patient has expressed a desire to leave. 2. The patient has attempted to leave during this hospitalization. 3. The patient has impaired decision-making capacity. 4. The patient has a court ordered legal guardian. 5. The patient has a history of any of the following during this hospitalization: (a) Wandering; (b) Attempted escape or elopement; Policy # A Elopement of Pediatric and Adult Patients 1

2 (c) Behaviors suggesting an intent to leave or seeking to find someone or something (standing by exits or stairwell, trying to open locked doors, watching staff from door of room); (d) The patient has attempted self harm; (e) The patient has suicidal ideation; or (f) The patient has a substance use disorder 6. The patient has been or is currently on a 72 hour hold. Interventions for Patients at Risk for Elopement For patients identified at risk for elopement, the nurse shall initiate the following interventions: 1. Attempt to engage the family to stay with the patient. Note: Family members may not be used as sitters for patients who are suicidal. 2. Change the patient into a purple gown. 3. Apply a purple armband. 4. Notify the physician for assessment, medication management, and an order for constant observation. Constant observation is defined as continuous visual observation between the patient and hospital staff or agency sitter in attendance. 5. In the event of a lack of hospital staff to provide constant observation, the Hospital Operations Administrator or Divisional Charge Nurse and/or the Staffing Office shall be contacted to arrange for staffing. 6. Document elopement risk status on clinical summary under Risk Screening and in the Patient Profile. 7. Ask the patient for reasons for his or her dissatisfaction with admission, non-adherence to treatment, and communicate to other team members. The following additional interventions may be employed as appropriate: 1. Initiate alarms interventions: bed, stop sign, etc. 2. Place the patient in a room near the nursing station, away from exits, and/or in room with camera. 3. Notify the attending physician for a potential psychiatric consult. 4. Employ diversional activities, i.e., activity apron, folding towels. 5. Increase the frequency of rounding to every 15 minutes or every 30 minutes. Response to Elopement If an Elopement Occurs: If a staff member is alone with the patient when the patient elopes, the staff member shall verbally attempt to detain the patient and call for assistance. The staff member shall not physically attempt to detain the patient from leaving. NOTE: Appropriate restraint may be used to detain a patient on 72 hour hold status. See Policy A08-120, Restraints and Seclusion. If the patient cannot be detained or has already eloped, the steps below shall be followed: 1. Within the first 10 minutes after the elopement, the nurse shall: Policy # A Elopement of Pediatric and Adult Patients 2

3 (a) Alert the unit staff; (b) Conduct a detailed search of the unit; (c) Notify the Patient Care Manager, Unit Manager, Hospital Operations Administrator, Divisional Charge Nurse, Attending Physician, and Security; (d) Provide a description of the patient to security, including the patient s name, age, gender, weight, race, clothing, time noted missing, other distinguishing features, whether accompanied by anyone, diagnosis (e.g., Alzheimer s), mental status, where last seen, room number, and direction of travel, if known; and (e) Notify Risk Management and the Administrator on call. 2. Within 30 minutes or sooner: (a) Security shall broadcast an Attempt to Locate (ATL) page for all available officers and notify UK police. (b) The nurse shall initiate an overhead page of the patient stating: Would (patient name) please return to (unit name). (c) The nurse shall notify the patient s next of kin or surrogate of the elopement and other relevant information. 3. Within 2 hours UK police shall: (a) Respond to the location of the elopement; and (b) Notify PPD, Parking, Lexington Fayette Urban County Government, and send a teletype to the Kentucky State Police. 4. For obstetrical patients, if the mother elopes post-delivery, the nurse shall initiate a social services consult and report the event to the Cabinet for Health and Family Services. Documentation Documentation for Elopement Risk The nurse shall: 1. Document Elopement Risk on Risk Screening Section on Clinical Summary; 2. Document elopement risk on Patient Profile; Documentation Post Elopement: The nurse shall: 1. Document Elopement Risk on Risk Screening Section of Clinical Summary; 2. Document elopement risk on Patient Profile; 3. Complete an incident report via the PSN; and 4. Include the following in a nursing note: a) The time the absence was confirmed; b) List the individuals who were notified and content of conversation (family, guardian); Policy # A Elopement of Pediatric and Adult Patients 3

4 c) The plans and efforts taken to locate the patient; 5. If the patient returns, the nurse shall conduct a physical assessment and document the patient s manner, appearance, affect, and verbalizations, document a plan for continuing care and safety, and complete and document a contraband search. 6. If the patient does not return within four hours, the nurse shall contact the physician to obtain an order for discharge, document continuing efforts to locate the patient, and arrange for disposition of the patient s belongings. References DeRosier, J., Taylor, L. (2006). Analyzing missing patient events at the VA. Topics in Patient Safety, 5(6). Retrieved from Gerardi, D. (2007). Spotlight case: elopement. Agency for Healthcare Research and Quality. Retrieved from Hunt, I., Windfuhr, K., Swinson, N., Shaw, Louis J., Appleby, L., Kapur,N., and the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness.(2010). Suicide amongst psychiatric in-patients who abscond from the ward: a national clinical survey. BMC Psychiatry, 10(14). Retreived from doi: / x Persons and Sites Affected Enterprise Chandler Good Samaritan Kentucky Children s Ambulatory Department Policies Replaced Chandler HP Good Samaritan Kentucky Children s CH Ambulatory KC Other Effective Date: 10/2012 Review/Revision Dates: 11/8/2012, 10/04/2013 Approval by and date: Signature Date Name Joanne Matthews, Psychiatric Clinical Liaison Nurse, Review Team Leader Signature Name Anna L. Smith, Chief Administrative Officer Signature Name Michael Karpf, MD, Executive Vice President for Health Affairs Date Date Policy # A Elopement of Pediatric and Adult Patients 4

5 Addendum A: Tips for Communicating With an Elopement Patient When communicating with patients at risk for elopement who are confused or lack decision making capacity and are trying to elope: Always begin speaking to the person by calling the patient's name and identifying yourself. Speak clearly and slowly. Always approach from the front. Use a calm voice and positive attitude. Always repeat your question exactly the same way. Give directions simply and one at a time. Give the person plenty of time to respond to your question (20 seconds). Keep facial expression warm and friendly. Make visual cues to re-enforce your words. Maintain good eye contact. Use non-verbal cues: a reassuring touch, a smile, a demonstration stating the emotion. Look for facial signs of understanding. Ask yes or no questions and use short simple phrases. Be specific. Use the name of the person or object instead of "this" or "they". Use concrete language. State your request in positive terms. Avoid using No or giving commands as these may increase resistance. Do not test the patient's memory by asking memory based questions. Avoid saying, "Don't you remember you were told to ask for help. stay in your room? Do not appear rushed or tense, the patient will become tense and agitated. Listen to the patient, try to find the key thought and take note of the feeling or emotion being expressed along with the spoken word. Offer reassurance. Remind the patient who you are and that you will take care of him/her. Watch for non-verbal communication of pain or discomfort such as grimacing, guarding or anger. Policy # A Elopement of Pediatric and Adult Patients 5

6 Addendum: BRISK ASSESSMENT ELOPEMENT ALGORITHM Patient Name: Unit: Date: Is the patient at risk for elopement during this hospitalization because? he/she lacks decision making capacity has expressed a desire to leave has attempted to leave has a court ordered legal guardian AND/OR Does this patient have a history of any of the following during this hospitalization? Wandering Attempted escape or elopement Behaviors suggesting an intent to leave or seeking to find someone/something (standing by exits or stairwell, trying to open locked doors, watching staff from door of room) Self harm or attempt at self-harm Suicidal ideation Substance Use Disorder A current 72 hour hold in place YES Notify Physician NO STOP Document in EMR Employ the following elopement nursing interventions on all patients assessed at risk Attempt to engage family to stay with patient. (Note: Only staff may provide constant observation with patients on 72 hour hold for suicide ideation.) Contact HOA or DCN for possible deployment of sitter. Notify the physician for assessment, medication management, and order for constant observation. Document elopement risk status on Risk Screening section on clinical summary and in patient profile. Ask patient for reasons for dissatisfaction with admission, non-adherence to treatment, and communicate to other team members. Change the patient into a purple gown. Apply purple armband Employ these additional interventions as they may apply Initiate alarms interventions: bed; stop sign. Place patient in room near nursing station/away from exits/in room with camera if available. Notify attending physician for needs assessment for psychiatric consult Use diversional activities (i.e., activity apron, folding towels) Increase frequency of rounding to every 15 minutes/every 30 minutes (circle one) Policy # A Elopement of Pediatric and Adult Patients 6