Just putting by a scenario here to find out what others would do in this instance.
65 year old patient with chronic confusional state as a current patient in an acute setting. Patient looks very 'well' and is physically very independent but assessments by pschiatrist and other MDT members and confirmed not safe to return home. Consequently requires placement in appropriate residential setting and so stuck in the beurocratic and hideous system of waiting for this to be actioned.
Level of confusion varies. Often settled but can frequent get desire to wander from ward and will want to leave in order to go 'home.' Usually persuaded to return to ward. Never shown any agrerssive tendandcies but will be strong in opinion that spouse is still alive when they are not. Does not always respond well to distraction.
On a particular evening patient had been quite agitated and so had already been given usual plus additional dose of Trazadone. Remained restless and wanting to leave. Reluctant to give further sedative as speech a little slurred but had already absconded from ward twice and was escorted back to ward by nursing staff.
Time was now 10:15pm and my shift had officially finished but as usual I was pfaffing about with a few things. Noted that the patient had gone from the ward again. Other staff were busy with a sick patient just returned from theatre and so I felt it reasonable for me to persue the pateint to where they had been found on one of the previous 'trips' off the ward. I took my jacket and told a HCA that I was going to look for the patient.
I found the pateint exiting the door into the carpark. Unfortnautely I did not have my phone with me but was able to advise security via a phone just inside the hospital door. I expained it was urgent and where I was but stated I had to go as the patient was going out of sight in the carpark.
With the patient in sight I held back to wait for security so that I could be seen. After several minutes they did not arrive. Persuasion to get the patient to return proved futile with them just continuing thier brisk walk out of the hospital gounds and on towards an area that is a mix of dense housing and parkland. It was quite cold at about 3 degrees C, not raining but obviously very dark.
So the question is....what would you do next?
Jan 22, '07
I'd have to run and catch up to the patient, walk beside him for a few seconds making light conversation, then gently steer the patient back toward the hospital. Or take a chance and say, "Mr Blank, Mr. Blank! My dear, you're going the wrong way! It's this way!"
If he's dead set on leaving, I would coax him back by telling him that his belongings are still there and hospital policy is such that the belongings cannot be picked up by anyone else. So he needs to come back to the room and sort out which are his, etc.
---And I would never, ever leave the unit without a phone again. Our policy is that we have a phone while we are on duty, so technically, I could get into a bit of trouble for not having it.
Hospitals need to have a good policy in place for this type of situation. We have a Code that we call for patients who try to elope. Those patients wear a certain color armband that makes staff aware of the risk. When a Code of that type is called over the loudspeaker, EVERYONE drops what they are doing and searches for the patient. Security usually comes running to help get the patient back into the hospital if the patient is found.
Other facilities go one step further and have Wanderguards placed on ankle or wrist of the potential Elopee, and warning alarms go off when patient leaves the room or the unit.
For some reason, many dementia patients respond to Stop Signs, so they are another option.
Hope everything worked out well for your patient and you!
Last edit by UM Review RN on Jan 22, '07