What would you do re Wandering Patient?

[TraceyJ]

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?

[UM Review RN, ASN, RN]

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.

http://www.seniortechnologies.com/content/productinfo/wg/residential/05Portable%20WanderGuard%2016600.pdf

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!

[MALE*RN*777]

Angie has some good points and there should be a code for an elopement pt. like she explained. The hospital could also have something like a "Wanderguard" which is a device (armband) that will lock the exit doors if the pt. gets to close and can be deactivated by the nurse/staff. You might also request that some things from the pts. home bedroom be brought in to be placed in the pts room which might make them feel they are at home. Signs and pictures near their door and at the exit reminding them where to go may help. Make sure you write up a good report and an incident report that clearly states what happened so that the hospital would/could be held responsible for this happening after they have the knoweledge that this is a serious problem. I have to say, good job with the responsibility part that shows you care about the patients but be careful.

[madwife2002, BSN, RN]

Very difficult situation I would have probably notified the local police because they have always been helpful when I have encountered similar situations. They are well trained to deal with these kind of situations-I had one pt actually get to the train station before the police found him and brought him back. Most police tend to be very sensitive when dealing with these kind of problems and had he gone from the hospital grounds then I believe the security guards have no durisdiction and the police have to be notified anyway.

In the Uk there is no such thing as wander guards or even bed alarms in most hospitals, and a lot of time very few staff to watch the patient. There really is no such thing as sitters.

[english_nurse]

Very difficult situation I would have probably notified the local police because they have always been helpful when I have encountered similar situations. They are well trained to deal with these kind of situations-I had one pt actually get to the train station before the police found him and brought him back. Most police tend to be very sensitive when dealing with these kind of problems and had he gone from the hospital grounds then I believe the security guards have no durisdiction and the police have to be notified anyway.

In the Uk there is no such thing as wander guards or even bed alarms in most hospitals, and a lot of time very few staff to watch the patient. There really is no such thing as sitters.

we had a patient sitter system last year called bedwatch which was for patients of this type plus sectioned patients, patients with withdrawal symptoms etc but the plug was pulled on this due to finances.

it was very useful as we are often so short staffed patients who are confused can be at risk,.

after being assualted twice at work over the last 12 months i can honestly say i wish we still had the system, these days unfortunately they end up being chemically restrained which is not in their best interests.

[UM Review RN, ASN, RN]

Very difficult situation I would have probably notified the local police because they have always been helpful when I have encountered similar situations. They are well trained to deal with these kind of situations-I had one pt actually get to the train station before the police found him and brought him back. Most police tend to be very sensitive when dealing with these kind of problems and had he gone from the hospital grounds then I believe the security guards have no durisdiction and the police have to be notified anyway.

In the Uk there is no such thing as wander guards or even bed alarms in most hospitals, and a lot of time very few staff to watch the patient. There really is no such thing as sitters.

Here, if those things are not in place and a patient should go off and get hurt, we'd be sued. So facilities use these things to demonstrate that they've done everything they can to prevent falls/elopement.

[TraceyJ]

Thanks for the replies so far. I think it's interesting that systems differ from the US to the UK.

Unfortunately a locked door system is a bit of a no-no mostly on grounds of practicality. Essentially it is a unit for patients without mental illness and so the three exits on the ward are frequently in use. I agree with the 'sitter' facility that has been referred to and it is often the case that when situations are difficuly, we are permitted to request an extra nurse to 'special' and give 1 to 1 ratio to the person causing difficulty. In the example given however, there had not previously been the need for this as any confusion was contained relatively well. This absocndment was pretty much an unpredicted escalation; earlier on in the day the patient had been perfect!

So just wondering then, is the consensus to go with the patient on their little jolly or to return to the hospital to get more help?

[janelola]

Hi,

Is your question more about whether or not you'd run out in the dark unasisted after patient or wait for back up?

Well, I don't mean to sound uncaring but I'd have to say not to run after patient and I would call the police. Yes, you are there to care for your patients, but your own personal safety must come first and it didn't sound like a very safe environment to go running off into.

Janelola