What if your patient goes missing?

What happens when a new nurse has an unexpected patient in her care?

What if your patient goes missing?

Ann was not a run-of-the-mill patient for the surgical floor. Actually, she was not a surgical patient at all. An elderly woman who had fainted, Ann needed to be hospitalized for observation and to rule out the possibility of stroke or M I. These serious conditions had been eliminated, and as she had no other obvious medical issues, she seemed like an easy patient. But the night nurse warned me: "Watch out. If you don't keep a close eye on her she'll get away from you." It turned out that Ann had Alzheimers.

When I went to Ann's room to introduce myself and assess her, I was surprised to find a fully dressed, rather elegant silver-haired woman. She stood gazing out the window and spoke courteously. Her piercing grey-blue eyes and perfect posture gave an aura of intelligence and grace. However, her gaze disconcerted me. Her eyes eyes searched my face, crinkled with a puzzled look. She repeated my phrases and questions back as if testing out the words of a foreign language. "Your daughter is coming to pick you up this afternoon. Please just stay here in your room to wait for her." I found the simpler my instructions, the better. "My daughter..." she repeated deliberately and then paused. "But'" she turned to me, her eyes puzzled, "what am I supposed to do now?" I thought for a second. It was a good question. "Well, nothing, I guess. Just relax. Take it easy. I'll take care of everything. Just wait here." I really didn't know what else to say and hoped to reassure her.

Ann could not be kept in a hospital gown. The moment she was left alone, she managed to dress herself in her street clothes again. At first the "leads off" alarm on the telemetry screen would betray her activities. Then she learned not to disturb the wires or the telemetry box which she wore tucked into the waistband of her khakis. I did not see the point of enforcing a hospital gown on her, so I let her wear what she wanted. Except for the tele box and the belt she had ingeniously fashioned from the ted-hose, she looked more like the average slightly-disoriented-nana visiting Billy in room 32. As a result, Ann avoided detection when wandering away.

I had repeated to her patiently, "Please stay here. Don't go anywhere. I don't want you to get lost or hurt." She was infuriatingly cooperative and polite. "Yes, yes. I'll stay right here." But then she disappeared. Her "civilian" dress and lack of outward signs of illness made it easy for her to escape notice. Despite measures such as a motion alarm on the entrance to her room and special instructions given to the nurse aides to keep an eye out for her wanderings, she was gone.

When she disappeared, I panicked. I raced about looking everywhere and sending out the alert for a wandering patient. Luckily, she didn't get far. Within a few minutes I saw her being escorted cooperatively back onto the unit, chatting pleasantly to her companion as if she were out for a stroll with an old friend. As I approached her I couldn't control my frustration. "Where did you go? I told you to stay in your room and I had to send everybody out looking for you." I trembled with frustration and relief that she was back safe. Ann's eyes widened in surprise and concern at my emotional outburst.

Later as I charted at the desk I felt a hand on my shoulder. I looked up to see Ann standing right next to me, with her companion a step behind. Her piercing blue-gray eyes sparkled with a purpose. "Don't worry honey. You'll be just fine." The tone of her voice was concerned but self-confident. She patted my hand patronizingly, gave it a little squeeze, and then continued past with her companion. Although I knew she didn't really comprehend that she had caused my stress, in that moment she had sensed and responded to my anxiety in a touching way. "Thanks, Ann." was all I could say.

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HKBrandon

About HKBrandon, BSN, RN

Licensed RN BSN with 19 years of clinical experience in a variety of adult inpatient settings who is passionate about learning, writing, and research.

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Specializes in retired LTC.

Thank you, God!!!

That's all I can say as God was with me during all my employment in LTC/NHs. As UM and supervisor for 3-11 & 11-7 positions, I never had to experience that sinking 'gut feeling' when a resident elopement was suspected. On occasion, we'd temporarily 'misplace' a resident, but no AWOLs.

I worked at facilities where residents had eloped with fatal results. So I never took it for granted that all were 'present & accounted for'. I felt like a prison guard at times. (I'm reminded of that each time I watch "Shawshank Redemption' when Andy turns up missing.)

We can all marvel at the level of ingenuity residents exhibit such as the one in OP's story. And I'm sure we can all tell our own amazing 'lost & found" stories. And I came to learn that NO place is 'un-hide-able'. Every nook & cranny is possible.

But I have heard the anguish of staff who have been held accountable when elopements have occurred. I never want to go thru that.

For staff who deal primarily with an elderly population, esp LTC, it is imperative to be proactive re possible wanderers and escapees. Esp any security precautions that are established for your facility's general P&P and any particular residents. Elopements are considered as 'sentinel events' and may likely trigger a DOH investigation.

To newbie (and not-so-newbie) nurses, please take pt location safety awareness VERY SERIOUSLY.

I would take this topic so far as to rank it right up there with NARCOTICS COUNT safety!!!

TY to OP for bringing up the topic. I don't remember seeing similar here.

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Specializes in retired LTC.

I did find a couple semi- current elopement entries and several older ones.

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This was a great article. And years since I've dealt with elopement risks... When I graduated ( 1990 ) we were still allowed to restrain patients. I understand why restraints are no longer permitted, my question is: How can you keep track? If it's not a locked unit and you don't have eyes in the backs of your heads, what do you do? Especially in LTC where there are so many patients to a nurse?

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Alarms and rounding. In inpatient geriatric psych where I worked, someone is literally assigned to rounds and find where all the patients are every 15 minutes. In an Alzheimer's and dementia unit, it *should* be locked and alarmed. Around here, a patient from a facility slipped out recently and was found frozen the next day. Horrible.

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I had one elopement in 20 years. Called security... who called the cops. Patient was found in their gown, in the middle of winter. A taxi driver picked him up and brought him back to the hospital. I was never so glad to see anybody in my whole life.

Elopement happens.

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Specializes in SICU, trauma, neuro.

I'm glad she was found safe! This is actually how my paternal grandma died... she was in a memory care unit solely for her wandering. Her husband had been caring for her at home with the help of her kids and an adult day program. He was doing an absolutely amazing job, but he was 90 and it got to be too much. If she was awake, she was wandering; when her family took her out for the day, we'd all take turns just following her to ensure her safety.

The door alarm failed. It simply didn't sound. She eloped sometime between 2000 and 2200, wearing only a top and slippers, in March in Wisconsin. It was under 20° F and she died of hypothermia.

The one time anything like this has happened on my watch, it was an a&o pt in an LTACH. He had made it known that he was going to leave. I had notified the dr to get the AMA ball rolling, and he proceeded to tell me why this was medically inappropriate. I was like "Yes I understand that, and I have explained it to him, but he IS LEAVING." He did leave while I was talking to the doc.

I wouldn't wish that sinking feeling on anyone... and he wasn't even wandering; he had simply chose not to continue his hospitalization. :no:

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

I've seen a number of patient elopements. Way back in the olden days (1970s), I took a job at a famous hospital to start work in their brand new building. As luck would have it, the new building wasn't completed until after I started my employment there, and I got to experience the joys of moving to a new building. We had one patient, a wiry and extroverted octagenerian who was given to wandering. One of the charge nurses scrawled a message across the back of his hospital robe in permanent laundry-marker: "Please return to 1 South" with the telephone number of our unit. It was the rare day when Floyd didn't get away from us at least once -- we were too busy to keep a constant eye on him and his escape artist skills rivaled those of Harry Houdini. The security guards knew him on sight (as did the Newborn Nursery nurses, as Floyd loved to visit the babies). I'm not sure what the visitors thought, but I don't remember any of them remarking upon it, either.

Moving day came, and Floyd was assigned to a nursing assistant under strict orders to keep him in sight at all times. She solved two problems at once by drafting him into pushing IV poles and rolling chairs over to the new building. Floyd was ecstatic at being able to help, and he actually WAS helpful. (Unlike many of those "keep 'em busy" assignments which created more work for the nursing staff. Floyd was friendly and courteous to everyone and the sight of Princess pushing a half dozen IV poles or a couple of rolling chairs followed by Floyd pushing just one was a frequent sight on the day of the move. Floyd got a huge kick out of chatting with all the folks he met in the halls along the way and even decided to buy lunch for "all you girls who are helping me move." We took up a collection, put an order together for the Greek food truck parked permanently in front of the hospital, and Princess and Floyd took a wheelchair out to pick up the lunch he was "buying" for us.

The day after moving day was a busy day -- no one knew where anything was and much of what we needed was in a big pile someplace, waiting for a permanent home. Princess was still on Floyd duty, but she got caught up in a code that afternoon and lost track of him. It wasn't until then that it occurred to anyone that Floyd's "Please return to 1 South" message was out of date. Even the phone number was different. Security was called and updated on the correct floor and phone number, but they were just as overwhelmed as the nursing staff and had hired a few temps who didn't know Floyd.

I came in to work an evening shift that night, and was surprised to see Floyd standing in front of the Greek food truck in front of the hospital arguing with the proprietor. He wanted to buy us lunch again, you see, but he had no money. He wasn't easily distracted this time, either. His heart was set on doing something for "all those girls who are working so hard." I emptied my wallet but it didn't come close to being enough, and in those days there were no cell phones. Besides, I hadn't memorized the number of the new unit. In the end, a couple of passing physicians helped me out and the proprietor made up the rest out of his own pocket (vowing, I'm sure, never to take an order from anyone wearing a hospital gown and slippers again). It took all four of us to carry the food up to the floor. I'll never forget the look on my manager's face as I stepped off the elevator with my arms full of food and trailing Floyd and the two world famous physicians who had come to the rescue!

Floyd got an updated sign on the back of his robe, and the physicians joined us all for "lunch". There was so much food that the Security guards rounding on our unit, RT and even a few nurses from the neighboring unit joined us. A few weeks afterward, Floyd got his long awaited nursing home bed. He was sadly missed for a long time, and I'm sure that even now there's a CNA or a nurse at that hospital who remembers moving day and Floyd's participation.

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We place elopement risk patients in a particular color of scrubs and their property is locked up and they do not have access. They will have a 1:1 placed if necessary or we can use a video monitoring system- a nursing assistant sits in a room somewhere watching all the cameras. For some we would sometimes use a chair tab alarm wrapped around the door handle that would go off if the door was opened.

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I am so sorry for your loss! Every patient is someone's grandma, father, daughter, sister... The risk of elopement is even more real when facilities don't have adequate staff to patient ratios. Our unit was not designed for this kind of patient! The charge nurse was able to get us a "sitter", a staff who's job it was to stay with one patient at all times. I'm thankful it ended well in this case. It could have easily gone the other way.

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