elopement risk

[tiger]

hi. i work on a rehab that is inpatient but our unit is totally separate from the hospital and security is only there at night. even then he is not much help with pts. running away due to our track record. there are 5 areas to exit the hospital. docs are hesitant to say the least to write an order for one to one supervision even after the pt. has escaped several times. if i have 6-7 pts. i cannot watch one of them continuously. i document when the pt. has attempted to leave or actually left and been found at the store down the road but this goes on too often in my unit and one day a pt is going to die. some are with it but some are very confused and only know that they want to get away. we had one leave twice this week to be found at the shopping area about a block down. he is a head injury. anyone else have this type of problem?????

[tiger]

oh, i forgot to mention. if a pt. says anything suicidal--like i wish i could die--they are usually put on one to one supervision. most cannot even get out of bed by themselves. does this make sense. at least those in bed can be monitored easier than those that walk/run quite well.

[frustratedRN]

we have patients like that all the time. especially now that we are getting the overflow from the psyche hospitals. lots of junkies leaving with needles. makes access ever so much easier for them.

they get their fixes and then come back. we take them of course.

our docs are pretty good about the sitters. they dont have to state suicide intent to get a sitter. if its someone we cant control they order one.

my brother was in an accident last new years eve. he had head trauma and was in a rehab hospital. all the doors were locked and they put a band on him and his wheelchair so that an alarm went off when he neared the door. used restraints too. hated to see him like that but it was better than him running.

we generally try other things before we get a sitter. we try the bed alarms, restraints, pharmacutical restraints, and then a sitter when those fail.

no you cant watch all those patients.

[WashYaHands]

I work per diem at a rehab hospital and we have occasional elopement risk patients. Once a patient is classified as an elopement risk, we take a poloroid picture of them and place it discreetly at each nurses station as well as at the receptionist desk at the main entry. We also use bed alarms and wheel chair alarms. If a sitter is needed we will first ask family members to help (if there is family). Sometimes we will use chemical restraint and other restraints, such as a posey bar on the wheel chair, but in my facility restraints are used as a last resort. I agree with you that it is a challenge to care for these patients and keep them safe.

[MaineNurse67]

I work in a 125-bed dementia facility... so I am well aware of the risk for elopement!

We use several different techniques to keep our residents safe from wandering out the doors and out into the world. We have all exits with code boxes which does help out a lot. We also have "Wander Guard" bracelets which set off an alarm when a resident passes a certain point. These make me a bit nervous because they are constant maintenance and not always 100% effective... we do have a routine maintenance program... but there is always that one that fails to work!

We use lots of different alarms... chair, bed, etc. The most effective alarm that we use is the motion detector alarm. We purchase them at Radio Shack... they are not all that expensive but are very effective in detecting when a resident gets out of bed or goes into an area that they should not.

We also have a "Code Silver" procedure... this relates to a missing resident. Once the staff have noted that someone is unaccounted for, then the code is called. All persons from that unit report to the nurse's station and are immediately assigned to certain areas of the facility to search. We, of course, do drills and constant education in this area.

So far, so good. But, I am always fearful of something happening. It is impossible to prevent every situation. And, I do not look forward to having my picture on the front page of the morning newspaper!

This is an ongoing problem for many facilities... a good topic for this forum! I will be watching to see other's ideas about this topic.

Tim

[tiger]

well, none of our doors are locked down. we used to use the alarm bands but it broke and has never been fixed. they do have the system that beeps when a door is opened but with 5 exits/entrances and everyone including staff, visitors, pts. that smoke, etc..., those beeps are not even noticed by anyone. they installed that right before some inspection and we told them it wouldn't help but basically we were told that yeah, they know it won't help but they had to make some effort before the inspection. so--money wasted. we need doors that lockdown on like all but one. but they claim fire safety won't allow. we also have a bus stop right out front. how convenient. we have actually had one pt--a while back before we couldn't use locked poseys as easily--anyway he couldn't walk, locked in his wheelchair. no money but the bus driver felt sorry for him. he was gone for hours before his boss called and said he had taken the bus to his job. i like the idea about some kind of code called overhead. as it is now everyone is not involved as quick as they should be. some of the pts. are fast.

[canoehead, BSN, RN]

If a patient leaves the unit, is not incompetent, can we force them to stay, or go after them to bring them back? I was under the impression that they must be declared incompetent. So if they leave we call the doc. If the doc wants us to stop them we must have a court order stating our right to infringe on their freedom, and why. Can anyone give clearer guidelines than that?