Elopement policy

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We are about to implement a hospital wide policy that prohibits the patients from leaving the unit if not for medical purpose. There is an exception that with physician order the patient may go off the floor but only with a staff member. It is a patient safety initiative. The thought behind it is, "if you are sick enough to be in the hospital, you need to stay on your unit where you are provided care".

I agree to this policy to an extent. It will cut down on the frustration of trying to do your job and the patient not being there. It also might distinguish the hospital from a hotel. What I am not looking forward to is having to be the enforcer and also catching patients smoking in their rooms.

Where I work some patients stay for weeks or even months at a time. Getting off the floor is an element of sanity in those cases. If it has to be with a staff member, I would like to know who that will be with.

Anyone have any experience or thoughts regarding this policy?

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What type of unit is this, psych??

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Specializes in Med/Surg, Ortho.

Somehow i dont see this policy standing. Maybe on a locked psyc unit, but if this is a general medical facility you have a big battle on your hands.

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Specializes in LTC, assisted living, med-surg, psych.

Ain't gonna happen.

People have rights, and if a facility tries to restrict adults between the ages of 18 and 65 from moving about as they please, that facility's going to have charges of false imprisonment leveled against it at some point. Not to mention a LOT of ugly confrontations.

Such a policy may even rile the most compliant of patients. I remember being told once when I was in the hospital after childbirth that I wasn't "allowed" to leave the floor without my doctor's "permission"..........I was 30 years old, for Pete's sake. I just looked at my nurse and said, "Do you have any idea how long it's been since I had to 'ask PERMISSION' to do anything??!!":nono:

I understand that it's a PITA to try to keep track of patients sometimes. I was a Med/Surg nurse for years, and it was a source of irritation to have to go looking for a patient who'd gone off the floor to smoke, visit the gift shop, or check on someone they knew on another unit. Most of our patients weren't well enough to do so, of course, but the ones who were........well, we knew better than to try and restrain them from making their appointed rounds.:uhoh21:

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Specializes in ER/Trauma.
People have rights, and if a facility tries to restrict adults between the ages of 18 and 65 from moving about as they please, that facility's going to have charges of false imprisonment leveled against it at some point. Not to mention a LOT of ugly confrontations.
Ayyyyup!
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At one job we had a policy that patients couldn't leave the floor to smoke without an MD order saying they could. I'd make the doctors write the order (AND made them add that they could leave the floor WITHOUT nursing supervision, because I wasn't going to go outside and watch them). If the doctors weren't willing to write the order, I made it very clear that I wasn't a babysitter, and per policy, I was making them AMA the second they hit the door. Very soon, we no longer had that policy. We were to simply use our "communication skills" to "discourage leaving the unit to smoke." Yeah, right.

People will do what they want to do. And the hospital isn't going to check these people out AMA and lose that insurance money. They're going to come down on the nursing staff for "letting" the patients violate policy.

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So far, no positive replys on this one. I work at a large medical facility. One thing that I have found about working there that I do not like is the competition to do what other hospitals of their size are doing.

The goal of the elopement policy is to prevent codes and patient accidents while off the floor. I think January 07 we are becoming a smoke free campus, with standing delegated orders on nicotine replacememt and employee assistance with nicotine replacement.

I'm interested to see how both of these play out....

Someone asked if I work on a psych unit. Sometimes it feels like I do, but I take care of liver and kidney transplant patients.

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My facility became smoke free July 1. We'll see how that goes. So far no major issues, surprisingly. We can not hold someone against their will, IF they insist on leaving the floor to smoke, ultimately that is their right to do so. Of course, they must sign a consent. I never go with a patient. I'm too busy. And I explain to them they are risking their own health (not the smoking but leaving the floor).

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Someone asked if I work on a psych unit. Sometimes it feels like I do, but I take care of liver and kidney transplant patients.

Thanks for the reply. I asked if it was psych because elopement

is one of the safety issues. If the hospital wants to go with this

policy, they better have enough staff consistantly to accompany

the patients. If not, the first time a patient is not with a staff

member off unit (because of short staffing) they have now violated

their own level of safety if the patient codes/gets injured/or leaves.

An attorney could see that as negligence secondary to their own hospital

policy.

They are opening themselves up to all sorts of legal issues,

including patient rights.

Good luck-let us know how it turns out.........

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Specializes in Geriatrics/Oncology/Psych/College Health.
It is a patient safety initiative. The thought behind it is, "if you are sick enough to be in the hospital, you need to stay on your unit where you are provided care".

My experience has been that this is more of a reimbursement issue. Insurers paying for expensive inpatient stays take a similar view: that if you can be unattended off the unit, you're not sick enough to be in the hospital.

(When I was first working psych, patients were allowed to go out on passes. This was extraordinarily frustrating when folks who were there for addictions returned high/drunk. That policy was discontinued, and it was generally understood that reimbursement was the reason.)

Good luck with the transition :).

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Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

I had a patient throw a suitcase at me when I told him he really shouldn't leave the floor. It missed, but when his doc came to the floor the patient clocked him one.

I don't see how you can forbid an adult to do anything. You can advise of the consequences, such as non coverage by the insurance company. Otherwise call the doctor and if possible have them sign an AMA release.

We went smoke free -gosh- in the late 80's. Patients either had to accept the patch, or go cold turkey, but they were not to smoke. There had been a huge room fire that killed the patient, melted the bed, walls, and floor and injured the nurse tech who attempted rescue. For many years that melted bed stood witness on the loading dock and was used in annual staff training.

As far as parameters for elopement I GOOGLED:

http://www.google.com/search?sourceid=navclient&ie=UTF-8&rls=GGLG,GGLG:2006-25,GGLG:en&q=patient+elopement+policy

There are a couple that are really good.

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We had a young man that left the floor, and went outside to smoke with a friend. When he came back and was getting into bed he collapsed -a cardiac arrest. Turns out he and his buddy were smoking crack (it was in his coat pocket). He survived and signed out AMA the next day.

It's not fair to the hospital staff to have to be responsible for that type of behavior and its aftermath. Our facility gets around this by enforcing "Universal Precautions". You don't get to wander around, you're all an infection risk-passing along or receiving.

There are rules everywhere, schools, churches, shopping malls AND hospitals. Adults need to respect that.

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